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Full text of "The American journal of the medical sciences"

THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



COLLABORATORS. 



Jacob Bigelow, M. D. Professor of 
Materia Medica in Harvard Univer- 
sity, Boston. 
Edward H. Barton, M. D. of St. 

Francisville, Louisiana. 
Henry Bronsojn, M. D. of Albany, New 

York. 
Walter Channing, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard University, Boston. 
N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 
John Redman Coxe, M. D. Professor 
of Materia Medica and Pharmacy in 
the University of Pennsylvania. 
D. Francis Condie, M. D. of Phila- 
delphia. 
William C. Daniell, M. D. of Savan- 
nah, Georgia. 
William P. Dewees, M. D. Adjunct 
Professor of Midwifery in the Univer- 
sity of Pennsylvania. 
S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of the state of 
South Carolina. 
Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 
Gouverneur Emerson, M. D. of Phila- 
delphia. 
Paul F. Eve, M. D. Professor of Sur- 
gery in the Georgia Medical College. 
John W. Francis, M. D. Professor 
of Obstetrics and Forensic Medicine 
in Rutgers Medical College, New 
York. 
W. W. Gerhard, M. D. of Philadelphia. 
William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 
R. E. Griffith, M.D. of Philadelphia. 
E. Hale, M. D. of Boston. 
Robert Hare, M. D. Professor of Che- 
mistry in the University of Pennsyl- 
vania. 
George Hay ward, M. D. Junior Sur- 
geon to the Massachusetts General Hos- 
pital. 
Thomas Henderson, M. D. Professor 



of the Theory and Practice of Medi- 
cine in the Columbian College, Dis- 
trict of Columbia. 

William E. Horner, M. D. Professor 
of Anatomy in the University of 
Pennsylvania. 

David Hosack, M. D. Professor of the 
Institutes and Practice of Medicine 
in Rutgers Medical College, New 
York. 

Ansel W. Ives, M. D. of New York. 

Samuel Jackson, M. D. Assistant to the 
Professor of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania. 

Valentine Mott, M. D. Professor of 
Pathological and Operative Surgery 
in the College of Physicians and Sur- 
geons, New York. 

James Moultrie, Jr. M. D. Professor 
of Physiology in the Medical College 
of the state of South Carolina. 

Reuben D. Mussey, M. D. Professor 
of Anatomy and Surgery in Dart- 
mouth College, New Hampshire. 

T. D. Mutter, M. D. of Philadelphia. 

R. M. Patterson, M. D. Professor of 
Natural Philosophy in the University 
of Virginia. 

Philip Syng Physick, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Co- 
lumbian College, District of Colum- 
bia. 

Ash bel Smith, M. D. of Salisbury, 
North Carolina. 

A. F. Vache, M. D. ofNeiv York. 

John Ware, M. D. Assistant Professor 
of the Theory and Practice of Physic 
in Harvard University, Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer on Ana- 
tomy and Surgery, New York. 
Thomas H. Wright, M. D. Physician 
to the Baltimore Aims-House Infir- 
mary. 



EDITOR— Isaac Hats, M. D. 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



VOL. XIII. 



PHILADELPHIA: 
CAREY, LEA & BL.ANCHARD. 

1833. 



c^VlHS,.,.; ' 










!TO READERS AND CORRESPONDENTS, 



Communications have been received from Professor Dickson and Drs. Ger- 
harb, Thomas, Tfrnbull and Hulse; they shall have an insertion in our next. 

The reviews of Boott's life of Armstrong, and of Raspail's Chimie Organique, 
were received too late for the present No. 

Dr. Perrine's communications were received just as the last forms were 
preparing for press, of course too late to enable us to grant all his requests. 

Our article on Cholera has been omitted to make room for the communica- 
tions of our correspondents. 

Our French Journals have, from some accident, not come to hand, but through 
the kindness of our friends we are indebted for the loan of them to the latest 
dates. 

The following works have been received: — 

A Report of the Method and Results of the Treatment for the Malignant 
Cholera, by small and frequently repeated doses of Calomel; with an Inquiry 
into the Nature and Origin of the Complaint, with a view to a more just appre- 
ciation of the Means for its Prevention and Cure. With numerous illustrative 
Cases. By Joseph Atre, M. D. Member of the Royal College of Physicians, 
&c. &c. &c. London, 1833. (From the author.) 

Clinical Illustrations of the most important Diseases of Bengal, with the re- 
sult of an Inquiry into their Pathology and Treatment. By William Twining, 
Member of the Royal College of Surgeons of London; First Assistant Surgeon, 
General Hospital, Calcutta. Calcutta, 1832. 8vo. (From the author.) 

An Essay on the Nature of the Epidemic usually called Asiatic Cholera, &c. 
with the Reasons why it should be regarded as an Epidemic Diarrhoea Serosa, 
instead of Common Cholera Morbus; and an attempt to found the Treatment 
upon the Pathology of the Disease: being the Annual Communication to the 
Medical Society of the state of New York, February 5, 1833. By Thomas 
Spencer, M. D. President: Honorary Member of the Kentucky and Philadel- 
phia Medical Societies; Corresponding Member of the Albany Lyceum of Natu- 
ral History, &c. Albany, 1833. (From the author.) 

Die Cholera. Nach eigenen Beobachtungen in der Epidemie zu Kbnigsberg 
im Jahre 1831, nosologisch und therapeutisch dargestellt von Dr. Lubwig Wil- 
helm Sachs, ordentl. Professor der Medicin zu Kbnigsberg, mehrer gelehrten 
Gesellschaften Migliede, Ritter des St. Wladimir-Ordens vieter Klasse. Kbnigs- 
berg, 1832. (From Dr. Von dem Busch, of Bremen.) 

On Irritable Uterus. By Walter Channing, M. D. Professor of Midwifery 
and Medical Jurisprudence in Harvard University. Being the Annual Discourse 
before the Massachusetts Medical Society. (From the author.) 

1* 



VI TO READERS AND CORRESPONDENTS. 

Some additional Observations relative to the Cholera, and a Prescription for 
the Treatment of that Disease in all its Stages. By Samuel A. Cartwright, 
M. D. of Natchez. (From the author.) 

A Discourse on the Privileges and Duties of Man as a Progressive Being, de- 
livered before the New York Alpha of the Phi Beta Kappa Society, July 23, 
1833. By Benjamin F. Joslin, M. D. Professor of Natural Philosophy in Union 
College. Schenectady, 1833. (From the author.) 

Workingmen's Library, No. IV. Vol. I. On the Treatment of Infants. By a 
Lady. Boston, 1833. (From R. Rantoul, Jr.) 

Address delivered in the Masonic Hall at the Commencement of the First 
Course of Lectures of the Medical Institute of the state of Georgia. By Paul F. 
Eve, M. D. Professor of Surgery. Augusta, 1832. (From the author.) 

Instructions and Observations concerning the use of the Chlorides of Soda 
and Lime. By A. G. Labab.raq.ue. Translated by Jacob Porter. Second 
edition. New Haven, 1831. (From the translator.) 

A Manual of Practical Toxicology; condensed from Dr. Christison's Treatise 
on Poisons. With notes and additions by J. T. Ducatee, M. D. Professor of 
Chemistry and Pharmacy in the University of Maryland, &c. &c. Baltimore, 
1833. (From the author.) 

The Edinburgh Medical and Surgical Journal, for July, 1833. (In exchange.) 

The Medico-Chirurgical Review, for July, 1833. (In exchange.) 

The London Medical Gazette, for June, July, 1833. (In exchange.) 

The Western Journal of the Medical and Physical Sciences. Edited by 
Daniel Drake, M. D. for July, 1833. (In exchange.) 

The Transylvania Journal of Medicine and the Associate Sciences. Vol. VI. 
No. 2. (In exchange.) 

The Medical Magazine, August, 1832? April, June, August, and September 
1833. (In exchange.) 

The Western Medical Gazette, No. 16. (In exchange.) 

Baltimore Medical and Surgical Journal and Review, October, 1833. (In ex- 
change.) 

Authors of new medical books, desirous of having them reviewed or noticed 
in this Journal at the earliest opportunity, are invited to transmit to the Editor 
a copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused by 
the circuitous routes through which they are received. 

Papers intended for publication, should be sent,/ree of expense, as early after 
the appearance of the Journal as possible, in order to be in time for the ensuing 
number. Such communications should be addressed to " Caret, Lea & Blau- 
chard, Philadelphia, for the Editor of the American Journal of the Medical 
Sciences." 

All letters on the business of the Journal to be addressed exclusively to the 
publishers. 



CONTENTS. 



ORIGINAL COMMUNICATIONS. 

ESSAYS. 

Art. Page, 

I. Removal of the Clavicle in a state of Osteo-Sarcoma. By John C. War- 
ren, M. D. 17 

II. Case of Rubeola followed by Death, collected at the " Hopital des En- 
fans Malades" of Paris. By W. W. Gerhard, M. D. of Philadelphia 20 

III. Practical Observations relative to the Use of Sulphate of Quinine in 
Febrile Affections. By J. W. Monett, M. D. of Washington, Miss. 33 

IV. Reports of Cases. By J. Young-, M. D. of Chester, Delaware County, 
Pennsylvania - 53 

V. On the Forces by which the Blood is Circulated. By Maurice Fitz 
Gibbon, M. D. - 62 

VI. Non-existence of Vagina, Remedied by an Operation. By John C. 
Warren, M. D. Professor of Anatomy and Surgery in Harvard University, 
Boston 79 

VII. Some remarks on Ataxic and Intermittent Fevers. By John B. Za- 
briskie, M. D. Physician to the King's Co. Alms-house, New York - 80 

VIII. Empyema cured by an Operation. By J. Pancoast, M. D. - 93 

IX. On the Penetration of Gases. By J. K. Mitchell, M. D. Professor of 
Chemistry, &c. in the Franklin Institute, and Lecturer in the Medical 
Institute - - 100 

X. A case of Ununited Parturient Laceration of the Recto-Vaginal Septum, 
successfully treated with Metallic Ligatures. By John P. Mettauer, M. 

D. of Prince Edward County, Virginia 113 

REVIEWS. 

XI. Clinical Illustrations of the more important Diseases of Bengal, with 
the result of an Inquiry into their Pathology and Treatment. By Wil- 
liam Twining, Member of the Royal College of Surgeons of London; First 
Assistant Surgeon, General Hospital, Calcutta. — ' Nihilque uspiam nisi 
quod probe exploratumhabeam.' — Sydenham. Calcutta, 1832. 8vo. pp. 
705 116 

XII. Mortality of the Metropolis.— A Statistical View of the Number of 



VIU CONTENTS. 

Art. Page. 

Persons reported to have Died of each of more than One Hundred kinds 
of Disease and Casualties within the Bills of Mortality in each of the Two 
Hundred and Four years, 1629-1831, &c. &c. &c. By John Marshall, 
Esq. 1 vol. 4to. London, 1832. 

The Population Returns of 1831, with a Statement of Progress in the In- 
quiry regarding the Occupation of Families and Persons and the Dura- 
tion of Life; an Historical and Descriptive Account of London, West- 
minster, and other parts of the Metropolis; a Comparative Account of 
the Population of Great Britain, in 1801, 1811, 1821, and 1831, &c. &c. 
&c. London, 1832. 

Natural and Political Observations mentioned in a following Index, and 
made upon the Bills of Mortality. By John Graunt, Citizen of London. 
With reference to the Government, Religion, Trade, Growth, Ayre, 
Diseases, and the several changes of the said city. London, 1662 - 149 

BIBLIOGRAPHICAL NOTICES. 

XIII. An Account of the Life, Lectures, and Writings of William Cullen, 
M. D. Professor of the Practice of Physic in the University of Edinburgh. 
By John Thomson, M. D., F. R. S. L. and E. Professor of Medicine and 
General Pathology in the University of Edinburgh. In two volumes, 8vo. 
Vol. I. Edinburgh and London, 1832 191 

XIV. In Inquiry concerning the indications of Insanity, with suggestions 
for the better Protection and Cure of the Insane. By John Conolly, M. D. 
Professor of Medicine in the University of London. London, 1830. 

pp. 496 203 

XV. An Essay on the Nature of the Epidemic, usually called Asiatic Cho- 
lera, &c. with the reasons why it should be regarded as an Epidemic 
Diarrhoea Serosa, instead of Common Cholera Morbus; and an Attempt 
to found the Treatment upon the Pathology of the Disease; being the 
Annual Communication to the Medical Society of the state of New York, 
February 5, 1833. By Thomas Spencer. M. D., President: Honorary 
Member of the Kentucky and Philadelphia Medical Societies, Corres- 
ponding Member of the Albany Lyceum of Natural History, &c. Al- 
bany, 1833. 8vo. pp. 131 20r 

XVI. A Report of the Method and Results of the Treatment of the Malig- 
nant Cholera, by small and frequently repeated doses of Calomel; with 
an Inquiry into the Nature and Origin of the Complaint, with a view to 
a more just appreciation of the Means for its Prevention and Cure. With 
numerous Illustrative Cases. By Joseph Ayre, M. D. Member of the 
Royal College of Physicians of London, and late Physician to the Gene- 
ral Infirmary, — to the General Dispensary, — and to the Lying-in Charity 

of Hull. London, 1833. pp. 167 208 

XVII. FUnfter Bericht iiber die verwaltung des Allgemeinen Kranken- 
hauseszu Hamburg, betreffend die Jahre 1828, 1829 und 1830. Bekannt 
gemacht von dem Verwaltungs-Collegio, 1832. Hamburg, 4to. pp. 108. 



CONTENTS. 



IX 



Art. Page. 

Fifth Report of the Administration of the General hospital of Hamburg for 
the years 1828, 1829 and 1830. Published by the College of Administra- 
tion, 1832 212 

XVIII. The Cyclopedia of Practical Medicine and Surgery, a Digest of 
Medical Literature. Edited by Isaac Hays, M. D. Part II. Philadelphia, 
Carey, Lea & Blanchard, 1833 

XIX. An Essay on the Yellow Fever. By J. Gillkrest, M. D. Deputy In- 
spector General of Army Hospitals. From the Cyclopaedia of Practical 
Medicine. London. 1832. 8vo. pp. 39 

XX. Workingmen's Library. No. IV. Vol. 1. On the Treatment of Infants. 
By a Lady. Boston, 1833. pp. 48 



214 



218 



220 



QUARTERLY PERISCOPE 

FOREIGN INTELLIGENCE. 



Anatomy. 



Page. 

1. New Membrane in the Eye. By 
George H. Fielding, Esq. - 221 

2. Case of Hermaphrodism - 222 

3. Anatomical Anomaly - ib. 

4. Bilobed Uterus. By M. Moreau ib. 



Page. 

5. Bilobed Urinary Bladder. By 

M. Velpeau 222 

6. Open Foramen Ovale. By M. 
Pigeaux - ib. 



Physiology. 



7. Physiological Effects of various 
Gases upon the Animal System. 

By Mr. Broughton - - 223 

8. On the Effects of Compression 
and Dilatation upon the Retina. 

By Sir David Brewster - ib. 

9. On the Undulations Excited in 
the Retina by the Action of Lu- 
minous Points and Lines. By 

Sir David Brewster ■- - 224 

10. Case of Satyriasis produced 



by a Blow on the Occipital Re- 
gion. By M. Chauflard - 227 

11. Case of Paraplegia accompa- 
nied with Complete Constipa- 
tion, and the Suppression of 
Urine for Fourteen Years. By 
Sig. Monte-Santo - - ib. 

12. Two Extraordinary Cases of 
Fasting. By Dr. Schmalz - ib. 

13. Professor Weber's Experi- 
ments on the Sensibility of the 
Skin. By Dr. Allen Thomson 230 



Pathology. 



14. Fungus Hsematodes of the 
Bones of the Cranium, Inferior 
Maxillary Bone, and Liver. By 
Dr. Hankel 

15. Compression of the Medulla 
Oblongata, by the Odontoid Apo- 
physis of the second Cervical 



234 



Vertebra. Abscesses of the Cer- 
vical Vertebras. By Dr. Hankel 234 

16. Berzelius on the Chemical 
Constitution of Urine in Various 
Diseases. By R. H. Brett and 

G. Bird 235 

17. Pathology of Phlegmasia Do- 
lens. By Dr. Graves - - 237 



CONTENTS. 



Page. 

18. Arteritis and Spontaneous Gan- 
grene of the Right Lower Ex- 
tremity — Arteries and Veins 
plugged up with Coagula - 237 

19. Remarks on the Value of Pa- 
thological Anatomy. By James 
Johnson, M. D. - - - 239 



Fage. 

20. On Hydatids and their Con- 
version into Tubercles. By M. 
Kuhn .... 240 

21. Sudden death from Paralysis 

of the Lungs ... ib. 



Materia Medica. 



22. Therapeutic effects of the 
Syrup and Extract of the Shoots 
of Asparagus. By M. Gendrin 241 



23. New Preparation of the Caus- 
tic Potash for Cauterizing. By 
Dr. Hennau 242 



Practice of Medicine. 



24. Anodyne Metallic or Galvanic 
Brush. By Francis Ernest Von 
Hildenbrand 242 

25. Asphyxia of New-born Chil- 
dren. By Dr. Patterson - 244 

26. Cases of Pleuro-pneumonia 



treated by Large Bleedings. By 

M. Bouillaud - - - 244 

27. Dysphagia. By Dr. Graves 245 

28. Use of Turpentine in Sciatic 
Neuralgias. By M. Martinet 246 

29. Arrest of Pain by a Magnet 247 



Ophthalmology. 



30. On the Reproduction of the 
Crystalline Lens, after the Ope- 
ration for Cataract. By M. Mayer 248 



31. Treatment of Amaurosis. 
M. Lisfranc 



By 



250 



Surgery. 



32. Fracture of the Os Hyoides. 

By Dr. Lalesque - - 250 

33. Case of Death after very pain- 
ful Injuries. By M. Roux - 251 

34. Two Cases of OZsophagotomy. 

By M. Begin - - - ib. 

o5. Notice of Acqua Binelli, with 
an Account of some Experiments 
made to Illustrate its supposed 
Effects. By Dr. John Davy 252 

36. On the various Sorts of perma- 



nent Flexion of the Fingers, and 
of their diagnosis. By M. Du- 
puytre'n - 

37. Formation of Callus, and the 
Means of Remedying it when 
Vicious or Deformed. By Baron 
Dupuytren ... 

38. Lithotrity. By M. Civiale 

39. Thirty-one Fractures in One 
and the same Individual. By Mr. 
Arnott - 



255 



256 
258 



ib. 



Midwifery. 



40. Two Cases of Artificial Deli- 
very. By M. Lovati - - 259 

41. Employment of Decoction of 



Belladonna in a Case of Rigidity 
of the Neck of the Uterus. By 
Dr. Ricker - - - 263 



Medical Jurisprudence. 



42. Case of Poisoning by Arsenic. 

By M. Orfila - - - 264 

43. On the Poisonous Properties 



of the Salts of Lead. By Dr. A. 

T. Thomson - - - 265 



Medical Statistics. 



44. On the Bearing of Epidemics 
upon Medical Statistics, and Po- 
litical Economy. By M. Villerme 266 



45. Mortality in France from Cho- 
lera 267 



CONTENTS. 



XI 



Chemistry, 



46. Acids of Nux "Vomica. 
Carriol --'.-- 



Page. 



By M. 



267 



47. Analysis of Rice. 
Darcet & Payen 



By 



Page. 
MM. 

267 



Miscellaneous. 



48. Epidemic Influenza in England 267 

49. Election of a Member of the 
Academy of Sciences of France 



to fill the vacancy caused by the 
death of M. Portal - - 268 
50. On the Qualifications of a Phy- 
sician. By M. Tiedemann - 269 



American Intelligence. 



A Case of Anastomosing 1 Aneurism 
of the External Maxillary Artery, 
treated successfully by Tying 
the Common Carotid Artery. 
By David L. Rogers, M. D. Lec- 
turer on Surgery, N. York - 
Case of Constipation successfully 
treated by the Introduction of 
Air into the Bowels. By George 
J. Janeway, M. D. 
Case of Prolapsus Uteri from Dys- 
menorrhea, together with the 
Formation and Expulsion of an 
Organized Substance. By John 
W. Malone, M. D. of Quincy, 
Middle Florida - 
Hot Springs of Virginia 
Description of a Safety Stirrup. 
By Samuel Jackson, M. D. of 
Northumberland, Penn. [Com- 
municated in a letter to the 
Editor] .... 
Case of Incongruous Twining, (No- 
sology, Good.) By Thomas J. 
Charlton, M. D. of Bryan Coun- 
ty, Georgia - 
On the Pathology of Cholera. By 
Charles A. Lee, of New York. 
[Extracted from a letter to the 
Editor] - - - 



271 



ib. 



272 
273 



274 



275 



276 



Case of Cancerous Breast, with 
Partial Ossification of that Or- 
gan. By John Maclellan, M. D. 
of Green Castle 

Case in which a Stiletto Remained 
for Twelve years Projecting into 
the Brain - 

Cases of Periodical Diseases treat- 
ed with Ergot, in Mississippi, 
1825. By Henry Perrine, M. D. 

Note on the supposed Efficacy of 
Peruvian Bark as an Antidote 
to Arsenic. By Henry Perrine, 
M. D. .... 

St. Augustine, East Florida, as a 
Resort for Invalids. By Dr. L. V. 
Bell - - - - 

Experiments on Nicotiana Taba- 
cura and Nicotine. By Joseph C. 
Turnpenny ... 

Cholera. By Dr. Drake - 

Cephalic Bellows-Sound. By Dr. 
John Fisher, of Boston 

Bourgery's Petite Chirurgie - 

Baltimore Medical and Surgical 
Journal and Review - 

Advertisements - 



277 



278 



279 



ib. 



285 
287 

289 
290 

ib. 

291 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



Art. I. Removal of the Clavicle in a state of Osteo- Sarcoma. By 
John C. Warren, M. D, Professor of Anatomy and Surgery in 
Harvard University, Boston. 

DANIEL SMITH, aet. 24, farmer, of Wayne county, Maine, admit- 
ted into the Massachusetts General Hospital, for a tumour of the 
right clavicle, November 1st, 1832. One year ago, in attempting to 
roll a heavy stick of timber 
over, placed both arms under 
it, bringing his chest firmly 
against it. Immediately after 
accomplishing his object, felt 
a severe pain at the junction 
of the right clavicle with the 
sternum. After finishing his 
work, he applied to a physi- 
cian for advice. It was pro- 
nounced an irreducible dislo- 
cation, but the swelling was 
lessened by warm, bitter fo- 
mentations. 

Continued to work, though arm quite weak till the month of Ail* 
gust last, when he quitted his labour, thinking he had " sprained the 
other collar bone." The following month, October, the swelling began 
to increase rapidly, and become hard. At times he felt as he thought 
*« rubbing of the bones." Now has a tumour measuring seven inches 
from sternal end of right clavicle in line with this bone to the scapu- 
lar end; from its upper bound* viz. the clavicle, towards the nipj>le*> 

No. XXV.— Nov, 1833. 3 




IS Warren's Case of Osteo- Sarcoma. 

five inches. Thinks it varies in size, being sometimes larger than at 
others; at times feels it pressing on windpipe: feels hard; no evident 
fluctuation; pulsation slightly perceived by stethoscope; some pain 
most of time, but increased by using arm or by coughing; pulse 84; 
no sensible difference in the pulsation at wrists; general health not 
materially impaired, but constitution scrofulous and irritable. 

9th. Some enlargement of tumour, extending to right shoulder. 

The preceding history is extracted from the hospital record. 

10th. Operation. — The patient being placed on a table, the shoul- 
ders elevated, an incision was made from the acromial extremity of 
the clavicle to the sternal extremity of the clavicle of the opposite 
side. This was crossed by an incison at right angles with it, begin- 
ning just below the middle of the sterno-mastoid muscle, and extend- 
ing to the face of the pectoralis muscle below the middle of the cla- 
vicle. The four flaps were then dissected from the surface of the tu- 
mour. Next the outer extremity of the clavicle was laid bare, by dis- 
secting the deltoid muscle from its anterior edge, and the trapezius 
from its posterior edge, and the division of the coraco-clavicular liga- 
ments. An eyed probe, armed with a ligature, was then passed un- 
der the clavicle, and the ligature being attached to a chain saw, this 
was drawn under, and the clavicle sawed through. 

The separation of the tumour now began. 

A strong ligature being passed around the outer extremity of the 
divided clavicle, the tumour was partially moved by it, so as to give 
tension to the surrounding soft parts. The pectoralis major muscle 
was cut through, and dissected from the lower edge of the tumour, 
and drawn so as to expose the pectoralis minor and the cephalic 
vein. Now the dissection extending under the tumour, the subcla- 
vian muscle was distinguished and dissected from the tumour at its 
outer part, but at the sternal part it was lost in the tumour, where of 
course the dissection proceeded over the surface of the subclavian vein. 
An adhesion of the tumour to the second rib, in which it was imbedded, 
prevented a perfect separation at this part till the close of the operation. 

The next step was to divide the attachments to the upper or 
cervical edge of the tumour. First the posterior external jugular 
vein was divided and tied: it was tilled with a dense lymph, and 
discharged no blood. Next the sterno-mastoid muscle was cut 
across, and the sheath of- the cerebral blood-vessels exposed. The 
internal jugular vein w r as perceived to pass from the neck into the 
substance of the tumour in such way as to render it difficult 
to dissect without dividing it. This was however accomplished, 
and then the carotid artery and par vagum nerve presented them- 



Warren's Case of Osteo-Sarcoma. 19 

selves. On reaching the internal extremity of the tumour, the ante- 
rior external jugular vein was found imbedded in it. This was 
filled with solid lymph, and was tied, as it would not have been safe 
to have left it without a ligature. 

Nothing now remained to be done, but to separate the sternal end of 
the tumour from the corresponding part of the jugular and subclavian 
veins. By great caution this was safely accomplished, and the tumour 
removed. When this was effected, the whole extent of the subclavian 
vein was exposed — the lower part of the jugular vein and the parva- 
gum nerve. These being put in motion by the pulsation of the subcla- 
vian and the carotid arteries, and the arteria innominata, presented 
a formidable appearance. 

Little blood was lost in the operation. Only one or two arteries 
were tied, and the veins specified above. The flaps were brought 
over and retained by three sutures and adhesive plaster, so as to 
cover the wound perfectly. 

The patient's appearance after the operation was good, and by a 
recurrence to the Surgical Diary, it appears his symptoms were most 
favourable to the thirteenth day. He was then able to sit up; had 
appetite; took small quantities of solid food, and had every promise 
of a favourable termination of his case. 

The wound united to a considerable extent by the first intention, 
and the ununited part went on favourably. On the thirteenth day 
he* was affected with chills, pain in the epigastric region, and his 
pulse rose from 80 to 112. These symptoms were followed by a 
nervous agitated state, and eventually by a slight delirium, with no 
other local phenomena than these above-mentioned. 

On some days he appeared better, and in a fair way to recover, 
and this hope was not abandoned till the day before his death, which 
occurred on the 8th day of December, in the fourth week from the 
operation. 

On examination of the body after death, a slight adhesion appeared 
at the point where the pleura corresponded with the wound, but this 
membrane in the vicinity of the wound was sound, and the lung not 
inflamed at that part. The inferior edge of the right lung was fringed 
with lymph. The lung of the other side had a more considerable ef- 
fusion of lymph externally; and in its substance, two or three spots 
of effused lymph, near an inch in diameter. A quantity of sangui- 
neous fluid was discharged into the left cavity. The heart and peri- 
cardium were unchanged. The brain presented nothing remarkable. 
The viscera of the cavity of the abdomen were healthy, except a 



20 Gerhard's Cases of Rubeola. 

slight blush where the intestines were in contact, and an enlargement 
of the right kidney* 

The subclavian vein, the upper part of the axillary, and the cepha- 
lic vein contained a coagulum, which was of long standing, and ad- 
hered closely to the coats of these vessels. 

On reviewing this case to discover the cause of the unexpected un- 
favourable result, we notice — 

First. That the patient was of a bad habit of body. He was natu- 
rally weak and excitable. 

Second. The absence of any local affection sufficient to be a cause 
of death. 

Whence it may be inferred, that the unfavourable issue was the 
result of constitutional irritation produced by the impression of a 
severe operation. 

Boston, July, 1833. 



Art. II. Cases of Bub cola followed by Death, collected at the " Hopi- 
tal des Enfans Malades" of Paris. By W. W. Gerhard, M. D. 
of Philadelphia. 

AN apology seems necessary to excuse the publication of observa- 
tions on measles, with an analysis of the symptoms and lesions of so 
common a disease. But such of our readers as have investigated the 
subject may know that the affections most frequently met with by 
practitioners are really least known, and that amongst the diseases 
of children, such of them as meningitis, which are comparatively 
rare, have been examined with much attention, while so extremely 
common an affection as measles is treated of in those general terms 
which can never serve as the materials for a complete history of the 
disease. The only treatise upon rubeola contained in the French 
medical literature which merits attention, is that of M. Guersent in 
the " Dictionnaire de Medecine;" but this essay is necessarily gene- 
ral, and is wanting in that degree of precision which is now requisite 
in every medical memoir. 

The following cases are intended as specimens of observations to il- 
lustrate the conclusions which will be published in another number of 
this Journal, and as all the original observations could not be commu- 
nicated, a part of them may serve as proof of the manner in which the 



Gerhard's Cases of Rubeola. 21 

facts were collected. Within the last eight months I have col- 
lected, at the Children's Hospital of Paris, about fifty cases of 
measles more or less detailed; the imperfection of some of them, 
arising in part from the difficulty of obtaining a correct knowledge 
of the symptoms of young children, but a still greater number 
are incomplete from circumstances which might have been obviated 
by greater attention. The publication of the whole number is 
of course impracticable, but all serve as the materials of an analy- 
sis which I am now preparing for publication in conjunction with 
my friend M. Rurz, Interne of the Hopital des Enfans Malades, 
and with the facts which he has himself collected they will form a 
mass of some extent. Every case is very far from answering all the 
questions which merit attention, but all present a more or less con- 
siderable number of symptoms; we have strictly confined ourselves 
to the original notes, and the analysis of each symptom is founded 
exclusively upon those cases in which its presence or absence is dis- 
tinctly mentioned. We have no hope of offering a complete treatise 
upon measles, but we believe that a memoir of this kind will furnish 
more precise data upon the complications and pathology of the dis- 
ease than a general treatise would have done. Facts must always 
have a certain value, and the smallest addition to the truths furnish- 
ed by observation will add something to the science. Besides, the 
time of theories is past, the necessity of positive knowledge founded 
upon laborious observation is felt, and the only writings adapted to 
the w r ants of the period are such as are rigorously confined to facts. 

The observations which follow are amongst the most interesting I 
possess, and of course offer instances of the disease which are either 
extremely grave or complicated with some other affection; it would 
be both fatiguing and uninstructive to relate cases of measles which 
are constantly occurring in the practice of all physicians. The great 
advantage presented by a large hospital like that of the Enfans Ma- 
lades is the facility with which symptoms may be compared with the 
changes observed after death, and the pathology of children rendered 
more clear by the abundant means of anatomical investigations. 

The three following observations from a group, which we class to- 
gether from the similarity of their symptoms and anatomical charac- 
ters; in the same manner the most important cases will be classed in 
order to elucidate the pathology of rubeola. 

Observation I. — A boy, eight years of age, entered the ward St. 
Jean, the 15th November, 1832; bed No. 13. Service of M. Bou- 
neau. He was born at Paris, is of a robust constitution, hair brown, 
not scrofulous; not vaccinated. Intelligence too obtuse to furnish any 



22 Gerhard's Cases of Rubeola. 

information. His mother stated to the sister of the ward that the 
eruption had appeared the day previously, preceded by cough and 
pain in the throat. He is habitually constipated. On the evening of 
the 15th the eruption was general, skin hot, pulse 116; respiration 
strong and noisy, but without rhonchus; hoarseness; dry, hoarse cough 
with pain in the throat. Four leeches to the throat. 

16th, morning. — Present condition. Irregular semicircular red 
spots a line or more in diameter, slightly elevated and discrete over 
the forehead; the rest of the face, especially the left cheek, is so 
much injected that the spots are indistinct — the redness is not regu- 
larly circumscribed; eyes red and weeping; sleep natural; senses and 
intelligence obtuse, but correct; no cephalalgia; eruption on the 
breast and abdomen very abundant, but more irregular than on the 
face — equally well marked upon the extremities, perhaps a little 
more upon the thighs than elsewhere; tongue deep red at its extre- 
mity, whitish, dotted with red papillae in the rest of its extent; pain 
in throat not increased, referred to the larynx; voice extremely hoarse; 
redness and moderate tumefaction of the fauces, without false mem- 
branes; abdomen tense and developed, but not tympanitic; no eva- 
cuation; heat moderate; pulse full, regular, 100; respiration regular; 
24 inspirations; mucous rhonchus general on both sides of the chest; 
percussion perfectly sonorous. Four leeches to the throat; poultices 
with vinegar to the feet; gum julep; infusion of mallows with acetat. 
ammon. 3ij.; diet. 

17th. Vomiting, without having eaten or drunk recently, of mu- 
cous flocculi in an aqueous liquid; one dejection; pulse 100 in the 
morning, 120 in the evening; cerebral function same state; respira- 
tion SO, heard at a distance, rather irregular, still offering mucous 
and sibilant rhonchi on both sides of the chest, especially the left; 
percussion sonorous. The eruption has assumed a deep claret co- 
lour on the abdomen and thighs; this colour is much less intense on 
the rest of the body. Cataplasms to abdomen and feet; infusion of 
mallows. The vomitings were renewed several times in the course 
of the 17th and 18th, the liquid assuming a greenish colour, and al- 
ways mingled with mucous flocculi. Eight leeches to the epigastrium 
the 18th. 

I9lh. Leeches bled freely. Vomiting renewed in the night; som- 
nolence; face generally injected; livid colour of the eruption dimi- 
nished; conjunctivae much injected with copious purulent secretion; 
heat elevated; nostrils slightly dilated; lips dry and deep red colour; 
mouth half open; decubitus always dorsal; pain in the throat felt only 
in coughing; voice stifled rather than hoarse; tongue very red at the 



Gerhard's Cases of Rubeola. 23 

point, whitish at the centre with some red spots free from the coat- 
ing; no change in the fauces; cough dry; no expectoration; respira- 
tion 36, irregular, interrupted by the frequency of the cough; pulse 
120; percussion sonorous; respiration noisy on both sides, vesicular 
expansion feeble, a little mucous rhonchus at the end of the inspira- 
tions; thirst; anorexia; constipation. Continue prescriptions. 

The livid colour of the spots disappeared on the 20th, and was re- 
placed by a pale-red tint; they were no longer visible on the face the 
21st, and very pale on the rest of the body; a slight fufuraceous 
desquamation existed on the arms. The stupor noted at his entrance 
increased daily; the 20th the patient was delirious, leaving his bed 
several times in the day; on the same evening (20th) we found him 
in a state of profound coma, with rattling stertorous respiration; the 
redness of the face rather diminished than augmented. The delirium 
returned in the night of the 20th to 21st. The child rose /rom his 
bed, and talked much in an incoherent manner. Coma in the inter- 
vals of the delirium, answers unintelligibly, and obtained only by 
speaking to him in a very loud voice; on the 22d delirium alternating 
with profound coma; no replies; slight subsultus of the tendons of the 
forearm with a little floccilation; pupils always natural; decubitus at 
first natural, afterwards abandoned. The redness of the conjunctivae 
augmented from his entrance; their secretion became purulent on the 
19th. The mucous secretion of the nasal cavities was replaced by an 
abundant purulent discharge the 21st. The lips were always dry, 
red, and swollen; tongue covered with a thick coating of viscid mu- 
cus the 20th, redness of the edges increased. On the 21st and 22d 
the mucus became drier, more abundant and brownish. The fauces 
could not be examined after the 20th, up to that date they presented 
the same appearance as on the previous days; voice always very 
hoarse; the pulse varied between 100 and 124 pulsations per minute, 
but rose the 21st and 22d to 164 and 180, it was always regular, 
full and strong at the beginning of the disease, small but quick to- 
wards the termination; the respiration augmented in frequency from 
24 to 36, never more frequent excepting in the evening of 20th dur- 
ing profound coma and threatened suffocation, regular, and not ele- 
vated at the earlier periods, it became high, irregular, and stertorous 
afterwards; the nostrils were never much dilated in the inspirations; 
the percussion of the chest was sonorous to the 20th, after that date 
the feebleness of the patient rendered it impossible; the respiration 
was always loud, without very marked vesicular expansion, it seem- 
ed stifled, and was mingled with more or less abundant mucous 
rhonchus every day excepting that of his admission. These charac- 



24 Gerhard's Cases of Rubeola. 

ters after the 20th could only be established in the anterior part of 
the chest. The appetite was wanting on the 19th, the only day on 
which it could be ascertained with certainty. Thirst always intense; 
deglutition easy until the supervention of coma; skin hot and dry; 
diarrhoea supervened the 20th, five to ten liquid stools daily; abdo- 
men always distended, but not evidently tympanitic until the 20th 
and the following days, at first not painful on pressure; after the first 
days the stupor rendered this symptom difficult to establish: pain in 
the throat was complained of upon coughing, but was soon rendered 
inappreciable from the coma. 

Treatment. — Three applications of leeches to the throat, epigas- 
trium and anus, in all eighteen, produced no effect on the progress 
of the disease. A bleeding of §viij. on the 21st during the coma, 
was followed by a sudden increase of the feebleness without other 
results. On the 22d three scarified cups were applied to the an- 
terior part of the chest, and blisters to each leg; an infusion of mallows 
with acetate of ammonia, 3ij. was given as his ordinary drink. Opiate 
enemata were ordered during the diarrhoea. On the 23d during the 
visit, he presented no new symptom, a few minutes afterwards on 
approaching his bed to examine him more closely, I found that he 
was dead. 

Jlutopsy, November %4th, 1832, tiventy-four hours after death. — 
Skeleton well formed, subject robust, adipose tissue abundant, violet- 
coloured ecchymosis on posterior parts of the trunk. Marks of two 
blisters on the thighs. Rigidity of the body considerable. 

Mouth and fauces, teeth and point of the tongue encrusted with 
blackish, dry mucosities; the hard and soft palate, uvula and tonsils 
are covered with a purulent coating half a line thick, yellowish and 
almost as consistent as a false membrane; its free surface is irregular, 
it adheres strongly, and when detached the mucous tissue is evident- 
ly red and swollen, adhering strongly to the cellular tissue, but not 
apparently softened. The same purulent matter extends into the 
nasal cavities, (which we could not examine,) and exists at both 
their anterior and posterior openings. Pharynx lined with the same 
matter, which ceases abruptly at its base, the mucous tissue is of 
the same aspect as in the mouth. (Esophagus pale, with its epithe- 
lium intact, follicles not developed. Epiglottis covered with the 
same substance, excepting its superior border which is red, swollen, 
at first sight resembling an ulceration, mucous membrane intact. 
Larynx contracted, uniformly lined by the purulent matter, ceasing 
abruptly a line below the ventricles which are filled with solidified 
pus, and scarcely visible. The mucous membrane is of a deep red 



Gerhard's Cases of Rubeola. 25 

colour, thickened, but not softened. Trachea of an intense amaranth 
redness, presenting at its anterior and lateral part on the right side, 
a long and irregular false membranous patch, beginning a little below 
the larynx, and terminating near the bifurcation of the trachea; other 
patches, but much smaller like little islands exist near it; the layer is 
softer and less adherent than in the larynx; mucous tissue of the 
same colour as in the rest of the trachea. Bronchix red, the left much 
less than the right, on the latter side they present a few yellowish 
patches not strongly adherent; the mucous membrane thickened, but 
not evidently softened. Puriform mucosities very abundant in all 
the bronchial ramifications. Bronchial glands rather larger than 
usual, red and a little softened. Pleurae non-adherent, containing al- 
most no serosity. Left lung reddish in its anterior part, brownish- 
red posteriorly, yielding an abundance of reddish, spumous serosity, 
but throughout soft and permeable to the air. Right lung of the 
same aspect as the left, except at the posterior part of the base of the 
lower lobe, where there are some lobules of a deep red colour, more 
intense than that of the surrounding tissue, not permeable but friable. 
A little cretaceous matter is contained in a cyst near the root of the 
right lung in its parenchyma; no tubercles found. Pericardium con- 
tains two or three drachms of lemon-coloured serosity. Heart larger 
than the fist of the subject, the left ventricle four lines thick at its 
middle, the right a line and a half. Tissue firm and very red, a 
large fibrinous coagulum in the right cavities, a little liquid blood in 
the left; the large vessels contain much liquid blood; membrane 
pale. 

Stomach contracted, presenting some viscid mucus on its anterior 
face, very little elsewhere. Mucous membrane rose-coloured and 
yellowish, with some little patches of dotted redness on its anterior 
face; mamillated in the large curvature. Thickness normal, con- 
sistence good, strips four lines in the large cul-de-sac, more than six 
on the faces, and from one to two inches in the small curvature. 
Small intestine moderately distended, containing a yellowish and 
rather liquid matter. Mucous membrane every where pale, except 
in the two last feet, where there are some arborizations. Consistence 
normal, except near the valve where it is a little diminished. Agglome- 
rated follicles scarcely prominent, not dotted with blue, pale, of the 
ordinary reticulated appearance. Isolated follicles very rare; me- 
senteric glands gray, very firm, of ordinary size. Large intestine 
tympanitic, a greenish matter less fluid than in the small intestine. 
Coecum grayish, almost of a slate colour, with one large vascular ra- 
mification; membrane yields no strips, a slight scraping reducing it 



26 Gerhard's Cases of Rubeola. 

into a pulp; it is more consistent at the beginning of the transverse 
colon, and in the rest of the intestine it is marked with some reddish 
longitudinal patches of a bright dotted redness, and becomes as soft 
as in the coecum. Follicles visible, but not prominent. Liver vo- 
luminous, of a pale brownish-red, greasing the scalpel a little; bile 
abundant and very pale. Spleen voluminous, four inches and a half 
in length; tissue of a dirty-red colour, soft, a slight pressure reducing 
it to a pulp. Kidneys pale; bladder pale, containing a little urine. 

Head, blood flows abundantly from the exterior of the dura mater. 
Pia mater much injected, very little serosity beneath the arachnoid, 
a few drops in the ventricles; cortical substance of the usual grayish 
colour, slightly rose-coloured; medullary portion dotted with red 
points, consistence excellent; cerebellum, medulla oblongata and 
annular protuberance without appreciable lesion. 

This observation is an example of measles occurring in a healthy 
boy, assuming a character of gravity at a very early period, and ter- 
minating fatally early on the tenth day of the eruption. The cause 
of death is sufficiently evident from the intense inflammation of the 
mucous membrane of the air passages, which resisted the treatment 
resorted to, and finally produced death by sudden suffocation. What 
are the symptoms of this secondary lesion? coma, intense dyspnoea* 
high, irregular, and even stertorous, but not very frequent respiration. 
The sonoriety of the chest, and the peculiar character of the respira- 
tion which was not at all bronchial, but stifled as if the air dilated 
the vesicles but imperfectly, and mingled with bronchial rales, dis- 
tinguish it from pneumonia. This stifled character which occurs very 
frequently in measles, and even in some cases of ordinary bronchitis, 
merits attention; and when existing in an intense degree, is strong 
evidence of violent bronchial inflammation, or at least engorgement 
of the lungs. In connexion with variety of morbid respiration, the 
sonoriety of the chest may be a little diminished, but the diminution 
is then general or nearly so, and can scarcely be confounded with 
the flatness afforded by percussion over a hepatized lung. The only 
other lesion of importance was the softening and almost complete dis- 
organization of the mucous membrane of the large intestine. 

Observation II. — Alexandre, set. 10, entered ward St. Jean the 3d 
April, 1833. Service of M. Guersent. Born at Paris, living in the 
Rue de Serres, 10th arrondissement, (a well-ventilated quarter.) Of 
fifteen children there remain but two, himself, (the 13th,) and a 
younger brother. The others died very young, one only having reach- 
ed the age of two years. He was vaccinated, has never been ill, and 
is not subject to cough. On the 26th March he was taken with cough 



Gerhard's Cases of Rubeola. 27 

and cephalalgia, he complained also of pain or oppression at the epi- 
gastrium. 

27th. Persistence of the symptoms with cough and frequent sneezing; 
anorexia from the beginning, but neither chill, vomiting, nor diarrhoea, 

28th. Eruption of measles, and diarrhoea for the first time. The 
eruption continued, with very mild general symptoms until the 31st, 
when he was attacked with severe pain in the breast and abdomen, 
intense dyspnoea, and difficult, noisy respiration; this sudden exacer- 
bation of the symptoms occurred while in bed without previous expo- 
sure to cold. 

April 1st. — He was bled without diminution of the symptoms, 
which retained their intensity until his admission. His mother pre- 
tends that the eruption had become much paler on the 1st, the change 
of colour taking place in a few hours, but a doubt remained on this 
part of her narrative. 

On the evening of the 3d April, dyspnoea extreme; respiration ele- 
vated with intense dilatation of the nostrils, 52 inspirations; pulse 
very frequent; skin very hot and dry; expression of the countenance 
anxious; eruption visible, but very pale. 

4th, 8 Jl. M. Present condition. Complexion fair; hair blond; 
eyes blue, brilliant, but not injected; no traces of enlarged ganglia 
or cicatrices at the neck, nor other marks of scrofulous affections; no 
emaciation; skeleton well formed; lips swollen, pale livid-red, dry; 
nostrils strongly dilated at each inspiration; no coryza; face in gene- 
ral highly coloured, the redness not in defined patches: a few of the 
characteristic spots of measles, of an irregular semicircular form, not 
elevated, very discrete, exist on the face, they are rather more nu- 
merous and of the same pale rose colour on the upper extremities, 
still paler and less defined on the trunk and inferior extremities; 
cephalalgia referred to the forehead; sight clear; ringing in both ears; 
drowsiness, almost stupor; decubitus dorsal; the knees elevated, with 
constant tendency to sink towards the foot of the bed; feebleness ex- 
treme, aphonia nearly complete; cough loose, moderately frequent; 
no expectoration; respiration high, irregular, 50 inspirations; pulse 
quick, strong, regular, 136; heat of skin very elevated; percussion 
obscure generally on both sides of the chest posteriorly, with no sen- 
sible difference; sub-crepitant rhonchus at the base of both lungs, in 
the rest of their extent inspiration not fully expansive but pure;* an- 

* This character of the respiration is frequently met with in children. I am 
in the habit of designating it in my notes as " soufflante?" it is difficult to find a 
corresponding English term. It is entirely different from the tubal bronchial 
respiration. 



28 Gerhard's Cases of Rubeola. 

teriorly, percussion sonorous on both sides, if there be a difference a 
little less on the right than the left; respiration on the left side per- 
fectly pure and natural, on the right it is a little less expansive and 
mingled with mucous rhonchus; pain in the throat, a little augmented 
by deglutition; redness and slight tumefaction of the fauces general- 
ly, without false membranes; thirst intense; he asks for food; no de- 
jections since his entrance; abdomen yielding, slightly tender on 
pressure generally. Venesection, §viij. ; two blisters to thighs; gum 
linctus with gr. v. Kermes; infus. malvae. 

5 P. M. The blood drawn the morning offered a large coagulum — 
the first cupful covered with a thin buff; pulse 180, quick, but more 
feeble; respiration irregular, varying from 40 to 60; oppression and 
heat intense. 

5th, 82 A. M. Eruption scarcely visible; face generally injected; 
lips intensely red and swollen; decubitus dorsal; nostrils dilated at 
each inspiration; same state of senses and cerebral functions; aphonia 
almost complete; feebleness extreme, but he supported the bleeding 
of yesterday well; heat elevated; respiration precipitated, irregular, 
45; pulse 135, small, regular, not developed; pain in the throat, 
slight even in deglutition; tongue intense purple on the edges, gray- 
ish in the rest of its surface; abdomen yielding, but painful; the child 
asks for food repeatedly; thirst; subcrepitant rhonchus in the whole 
anterior part of the right lung, perhaps more marked near the sum- 
mit than the base; respiration natural in the left lung, except a slight 
subcrepitant rhonchus at the lower part; percussion sonorous on both 
sides, perhaps a little less on the right; posteriorly subcrepitus and 
mucous rhonchus at the base of both lungs; respiration feeble, but 
without expiration, and not at all bronchial in the upper part of both 
lungs; percussion not changed; pulsations of the heart offer nothing 
remarkable but their frequency. Venesection, ^viij. ; repeat Kermes; 
cataplasms with vinegar to the ankles. 

6 P. M. Stupor increased; decubitus elevated dorsal; face inject- 
ed; heat increased; pulse 156, quick; respiration 68, less elevated; 
both pulse and respiration increased in frequency since the bleeding, 
which was performed at 4 P. M. 

6th. Decubitus dorsal abandoned; expression of anguish strongly 
marked; lips paler; pupils natural, eyes dull; feebleness extreme; 
face livid, pale; heat intense; thirst; aphonia continues; dyspnoea ex- 
cessive; respiration 52, very irregular, with mucous rattle heard at a 
distance, each inspiration accompanied with great dilatation of the 
nostrils; pulse 152, without particular character; no diarrhoea; feeble- 
ness prevents auscultation; blood presents a buffy coat. Teeth slight* 



Gerhard's Cases of Rubeola. 29 

ly encrusted; tongue continues swollen, of pale-rose colour at the 
edges, grayish at the centre. Potion, with gr. vj. tart, emet., 3ij. 
syrup of opium in ^ix. vehicle. §ss. q. h. Infusion of mallows. 

5 P. M. Pulse feeble, rather irregular, difficult to count, between 
160 and 170; respiration 45, very elevated; each inspiration attend- 
ed with a general tremulous movement of the body. 

Death the 7th, at 3 A. M. without vomiting or dejections, although 
he had taken the whole of his draught. 

Autopsy, the 8th, at 9 Jl. M. — Exterior. Rigidity of all the limbs; 
hands and feet slightly contracted; lividity of the posterior part of 
the body and interior of the thighs; slight greenish colour of the lower 
part of the abdomen; some scattered reddish spots are still visible on 
the hands and arms, the greater part resembling the pricks of pins; 
muscles highly coloured; no oedema, and moderate embonpoint. 

Head. Little blood on the exterior of the dura mater; a small, 
fibrinous coagulum at the posterior part of the longitudinal sinus; no 
serosity beneath the arachnoid or in its cavity; the pia mater can 
be easily detached from the convolutions without destroying them; 
pia mater generally a little injected; cortical substance of a dark- 
grayish colour, (like that of coffee diluted with much milk;) medul- 
lary substance generally of a violet tinge, and a little dotted with red 
points; a tea-spoonful of serosity in each lateral ventricle; substance 
of the brain, including the central portions, firm; cerebellum, me- 
dulla oblongata, and annular protuberance firm, pale. 

Mouth and throat. Tonsils a little injected, not evidently swollen, 
covered with a slight coating of mucus. Pharynx and oesophagus of 
a light rose colour; the follicles but little developed. Larynx, and 
epiglottis on its posterior face, present numerous little, rounded ele- 
vations, about half the size of mustard seeds, apparently follicles; 
each of these little elevations offers a yellowish point nearly as large 
as a pin's head, formed of a pseudo-membranous production, which 
seems a secretion from the follicles, to which it adheres but slightly. 
The mucous membrane in general is of a deep red or lake colour; the 
vocal cords a little thickened, and the cavity of the ventricles evi- 
dently diminished; the thickening extends to the whole membrane. 
The trachea is of the same deep red colour, and presents upon its 
whole surface, especially posteriorly, the same follicles with the yel- 
lowish secretion adhering to them; their central point cannot be dis- 
tinctly seen. The bronchia of the left side are of nearly as deep a 
red colour as the trachea, but without distinct follicles; those of the 
right side are also red, but of a much less intense colour than the 
left, the mucous membrane retaining its natural transparence, while 

No. XXV.— Nov. 1833. 4 



30 Gerhard's Cases of Rubeola, 

on the left side it is much more opaque than natural, and seems thick- 
ened, although firm, and resisting the scraping with the point of a 
scalpel. The mucous membrane of the trachea is of very good con- 
sistence, yielding a strip between twenty and twenty-four lines in 
length. The bronchia, especially the left, contain an abundance of 
yellowish mucus. 

Lungs not adherent; a little lemon-coloured serosity in each pleura. 
Right lung of a fawn colour, a little violet in its upper lobe; the ve- 
sicles of the summit uniformly dilated, of a diameter of about one- 
tenth or one-twelfth of a line, so that the summit of this lung forms 
a rounded protuberance very crepitant and distended with air. Mid- 
dle lobe of a violet-fawn colour, without manifest dilatation of the 
vesicles; inferior lobe of the same hue, a little reddish in its inferior 
and posterior part. Left lung of a deeper rose colour than the right 
in both its upper and lower lobes; this tint is only deep rose colour 
in the upper lobe both exteriorly and interiorly, whilst the lower lobe 
is of a deep red colour, containing an abundance of reddish, spumous 
serosity, and more friable than the upper lobe, approaching the ap- 
pearance of lobular pneumonia, but still floating in water. Bronchial 
glands of a livid blue, very voluminous, the largest situated at the 
bifurcation of the trachea is of the size of a small walnut and soft; 
like the lungs, they contain no tuberculous matter. 

Stomach neither distended nor contracted, containing the tisane 
he had taken. Mucous membrane of a pale grayish blue colour, 
shaded with yellowish bands which cross each other in every direc- 
tion. A few little patches of bright dotted redness, three or four lines 
in extent, are found along the small curvature. The opaque milky 
tint of the mucous membrane is general, but more marked in the large 
cul-de-sac than elsewhere. The consistence of the membrane is a 
little diminished, thus although the strips are of the usual length, 
(three or four lines in large tuberosity, six or seven in the large cur- 
vature, and more than an inch in the small,) yet they are brittle, 
and can only be detached by using great precaution. The general 
thickness of the membrane is perhaps a little increased, it presents 
an abundance of little depressions one to two or three lines in dia- 
meter, thickly scattered over the whole surface, in general rounded, 
some longer and more narrow, the edges are not elevated, and the 
whole depression presents the same colour as the surrounding mem- 
brane. The mucous membrane exists in all, but is very thin in some 
of them; the sub-mucous tissue is not rejected or affected. Small 
intestine a little distended, containing a yellowish matter and four 
lumbrici near the end. The mucous membrane is every where pale, 



Gerhard's Cases of Rubeola. 31 

and yields strips of the usual length, (six to eight lines.) Twenty- 
one agglomerated glands of Peyer, they present their normal ap- 
pearance, reticulated and covered with bluish points, (the orifices of 
the follicles.) Isolated follicles very numerous, and marked with a 
central point in the duodenum, not visible afterwards, except in the 
last one or two feet. Mesenteric glands bluish, rather swollen, of 
good consistence. Large intestine containing softened fecal matter, 
not distended; mucous membrane pale, excepting one or two reddish 
patches an inch or two long in the transverse colon, the mucous mem- 
brane a little less consistent than usual, strips of but four to eight 
lines, except in the rectum where they are rather longer. Follicles 
little developed. Liver of a bluish tint, engorged with blood, not 
fatty. Bile abundant. Spleen reddish, firm. Kidneys pale. Bladder 
pale. 

Heart contains a firm fibrinous coagulum in the right cavities, one 
smaller in the left: its volume is about one-half larger than the fist 
of the subject, tissue firm, of a deep red colour; thickness of the left 
ventricle at its middle, without including the columnse carneae four 
lines, of the right a line and a half. 

The analogy presented between this case and the preceding is ob- 
vious, the same lesion existing as the cause of death in both, but the 
purulent secretion which was found in a large extent of the respira- 
tory passages of the other subject, is here confined to some little 
points adherent to the follicles, and resembling the forming stage of 
false membranes in the large intestines of children. In short, the 
lesions are evidently identical, and indicated by symptoms offering 
few points of difference. The treatment in this case was more vi- 
gorous than in the preceding, but the three bleedings produced no 
diminution of the dyspnoea, and seemed in no manner to retard the 
fatal termination. The lesion of the stomach described is fre- 
quent among children; and by the disciples of the physiological 
school would doubtless have been referred in part at least to the 
antimonial preparations which the child had taken; but as the only 
mode of ascertaining the influence of this remedy in producing such 
a lesion, is to compare its frequency in the subjects who had been 
treated by the administration of tartar emetic, with the cases in which 
no active medicine had been directed, we think it would be prema- 
ture to hazard such an opinion. 

Observation HI. — A little girl, six years of age, belonging to a 
family of poor Auvergnats, who were compelled from poverty to place 
her at the hospital; she had been in the ward St. Catharine during 
some time, and at the moment her disease commenced, was discharged 



32 Gerhard's Cases of Rubeola. 

from the hospital, but allowed to remain there a few days until her 
parents could procure for her the means of livelihood. Her health 
was perfect, complexion florid, embonpoint marked. An eruption 
of measles characterized by the usual cherry red spots of the or- 
dinary form, appearing on the 11th January, 1833; preceded by vo- 
miting, cough, and sneezing, during the two previous days. 

12th. Sudden disappearance of the eruption, and extreme dyspnoea. 

loth. Face livid; redness in large rounded patches on each cheek; 
respiration irregular, very high, between 50 and 60; pulse 165; heat 
intense; decubitus dorsal; dyspnoea extreme. On placing the ear for 
a moment on the chest, the respiration could still be distinguished, 
mingled with rhonchus. An attempt was made to bleed her, but the 
vein yielded only about §ij. of blood. Death in the night. 

Autopsy, 15th, thirty-four hours after death. — Exterior pale, some 
livid spots on the posterior parts of the body; no infiltration; skeleton 
perfectly well formed. Head not examined. 

Thorax; slight adherences at the base of the left lung; upper lobes 
of both lungs rose fawn colour; their tissue is soft, perfectly per- 
meable to the air, and contain but little serosity, and no tubercles. 
The middle and lower lobes of the right, and lower lobe of the left 
lung are of a brighter rose colour anteriorly, and reddish posteriorly, 
containing reddish spumous serosity, but not very abundant, but 
light, soft, permeable, floating in water, in short, slightly congested 
with blood; oesophagus and pharynx pale; larynx slightly red; trachea 
and bronchia of a general livid red tint without, thickening or bright 
viscid redness, containing a moderate quantity of mucus. 

Heart, a few tea-spoonfuls of lemon coloured serosity in the peri- 
cardium; right ventricle and auricle distended by a large blackish 
coagulum; very little blood in the left cavities; aorta and large vessels 
pale. 

Stomach contracted, containing some whitish mucus; mucous mem- 
brane pale, slightly rose, with some large vascular ramifications on 
each side of the small curvature; not mammillated, of natural thickness 
and consistence. Small intestine contained one lumbricusand a little 
mucus. From twenty to twenty-five grayish agglomerated glands of 
Peyer, very little elevated, some dotted with blue points; isolated 
follicles numerous in the duodenum, and towards the end of the in- 
testine. Large intestine containing fecal matter; mucous membrane 
grayish, transparent, yielding strips eight or ten lines in length; fol- 
licles not visible; liver gorged with blood; spleen reddish, brown, firms 
kidneys a little livid. 

This short note does not merit the title of an observation. The 



Monett on Quinine in Febrile Affections. 33 

case occurred in a ward in which I was not engaged in observation, 
and was noted on account of its violence. The lesion seems to have 
been of the same nature as in the preceding observations; the only 
anatomical alteration was the redness of the trachea and bronchia, oc- 
curring in another subject; little importance would have been attach- 
ed to this lesion, but in this case the symptoms were precisely ana- 
logous to those remarked in the other cases, and is not in accordance 
with strict reasoning to conclude, that the short duration of the dis- 
ease will sufficiently explain the trifling lesions found after death. 



Art. III. Practical Observations relative to the Use of Sulphate of 
Quinine in Febrile Affections. By J. W. Monett, M. D. of 

Washington, Miss. 

A HE sulphate of quinine, and the sulphate of cinchonine, although 
similar in qualities, and derivable from the same source, are so dif- 
ferent in their therapeutic effects upon the human system, that I shall 
not consider them as identical or synonymous in the following re- 
marks. The common quinine of pharmacy contains the active febri- 
fuge or contra-stimulant property, and the cinchonine, most probably, 
the tonic principle of the cinch, offic. My experience being confined 
to the sulphate of quinine, I shall of course restrict my remarks to 
that substance, with only a passing observation relative to the sul- 
phate of cinchonia. This latter I have said most probably contains 
the tonic properties of the bark, as the quinine does the febrifuge. 
This remark is in part founded upon the authority of M. Bally, who 
has made extensive trials of both. He prefers the cinchonine as be- 
ing less irritating than the quinine. This irritating quality which he 
ascribes to the quinine, I hope, in the course of these observations, 
to show, is the result of its febrifuge and contra-stimulant properties, 
especially when administered in improper cases. Future experience 
may show, that there is one class of febrile diseases in which the qui- 
nine is the proper remedy; and another class in which it is decidedly 
injurious, and in which the cinchonine will be salutary and proper. 

It is now generally admitted, that the gray, or Loxa bark, contains 
the cinchonia; the yellow, or Calisaya bark, the quinia; and the red 
bark contains both in large quantities. This latter circumstance will 
account, on the principles set forth in this paper, why the red bark 
is so much preferable in protracted intermittents from debility, as it 

possesses largely both the tonic and the febrifuge essence. 

4* 



34 Monett on Quinine in Febrile Affections. 

Nothing requires closer observation and nicer discrimination, for 
useful practical purposes, than the introduction of new remedies into 
practice, or new articles into the materia medica. Although an arti- 
cle may be introduced, by general acclamation, as a new remedy, 
or as a substitute for those already in use; yet it not unfrequently 
happens that such article continues to be long estimated and used, 
with all the prejudiced views and want of discrimination with which 
it was proclaimed and adopted. Nor is it to be expected, under such 
circumstances, that its administration will be confined to those par- 
ticular cases solely, in which it is salutary and proper. Its prejudi- 
cial effects, even in those cases where it is decidedly injurious, will 
scarcely be observed, or properly estimated: for the advocates of a 
favourite article, blinded by their prepossessions will erroneously at- 
tribute its deleterious effects to the ravages of the disease they de- 
sign it to cure. 

I consider these remarks in point, and applicable especially to the 
sulphate of quinine. It has been generally introduced into practice, 
and by many of the profession, with a kind of idolatry, (too often 
seen in medical men,) not only as a substitute for the Peruvian bark, 
but also for almost every other class of medicines. The extent of the 
deleterious consequences, from an improper use of this article, are 
not clearly ascertained, because the whole testimony is prejudiced in 
favour of the medicine. 

As it is my object in the following observations to lay down and 
establish a true principle for the safe and salutary exhibition of qui- 
nine, I shall endeavour to draw a line of discrimination, and show 
the state of the system when it is, or is not proper. It will thus be 
seen that the condition of the system applicable to the use of quinine 
is the reverse of that in which the bark is indicated; and that instead 
of superceding the bark, it is only another auxiliary in the treatment 
of fevers. 

The bark having been used in all cases of remittent and intermit- 
tent fevers indiscriminately, must necessarily have failed to cure 
those cases in which its use was improper. The same result will ob- 
tain from a similar use of quinine. The bark is improper and perni- 
cious in all cases characterized by general increased arterial tone and 
action; or in fevers consequent upon local inflammation or engorge- 
ment, and where the tone of the system is unimpaired. If adminis- 
tered in such cases it will certainly disappoint expectation. The best 
Peruvian bark possesses a tonic and a febrifuge property combined. 
This combination of properties adapts it peculiarly to cases of fevers 
and febrile affections based upon an asthenic diathesis. This circum- 



Monett on Quinine in Febrile Affections. 35 

stance, in all cases, should form the criterion for its use, whatever 
be the name of the disease or its external character. The same pro- 
perty which adapts the bark to this class of diseases, renders it in 
the same degree pernicious in those of an opposite character. 

The quinine is salutary and proper, as a remedial agent, in cases 
the reverse of those in which the bark is applicable. The quinine, 
which has been erroneously supposed to contain the whole tonic pro- 
perty of the bark, is in fact its febrifuge essence uncombined and 
without any tonic property whatever. Thus, when quinine is impro- 
perly given, its pernicious effects are much more aggravated than 
those resulting from an improper use of the bark. For in the latter 
the febrifuge in some degree counteracts the tonic property, and vice 
versa: besides, the improper cases for bark, are those states in which 
the system is unimpaired by debility, and can withstand a temporary 
error without serious injury. On the other hand, the quinine exerts 
its febrifuge powers by directly diminishing the force and tone of the 
arterial system, and is injurious only in those cases where the asthe- 
nic diathesis prevails. In such cases, with an impaired state of the 
constitutional powers, atony in the circulating system, and all the 
train of rapid and fatal symptoms attendant upon adynamic fevers, 
even a temporary diminution of the powers of life cannot be sustain- 
ed without the most imminent hazard. When used in these cases, 
quinine, unlike digitalis, tart, ant, &c. instead of diminishing the 
force and frequency of the arterial pulsations, diminishes their force, 
but increases their frequency, together with all the signs of irritable de- 
bility. This is what M. Bally means by its irritating property; and 
this is what others have erroneously considered its stimulant effects. 
For while quinine acts as a febrifuge and contra-stimulant in sthenic 
diseases, it produces the highest grade of irritable excitement in those 
of direct debility. 

But in cases of open excitement, in vigorous constitutions, the qui- 
nine may be used advantageously in most of those cases of autumnal 
remittents and intermittents, in which tartarized antimony, digitalis, 
pulv. ipecac, c, saline diaphoretics, and medicines of that class 
might be safely employed. In such cases the system will not unfre- 
quently bear large doses of quinine without any visible effect; as is 
likewise often the case with tart. ant. and other medicines. But it 
cannot be otherwise than pernicious in all asthenic cases; and I con- 
sider highly preposterous an attempt to make it supercede many of 
our valuable remedies in the treatment of summer and autumnal 
fevers, especially in this climate and latitude, where most of our 
summer and autumnal diseases originate in the debilitating and re- 
laxing effects of heat. 



36 Monett on Quinine in Febrile Affections. 

It is truly a matter of astonishment, that this article should have 
been forced so extensively into the southern practice, where diseases, 
especially summer and autumnal fevers, are least adapted to its use. 
Yet such is the force of habit and preconceived notions in medicine, 
as in every thing else, that too often they usurp the province of judg- 
ment and discrimination; and medicines are often administered in 
certain cases, only because we have been in the habit of prescribing 
them in others. And thus it is with calomel and quinine. I doubt 
whether mercury itself, in so short a period, has ever produced more 
pernicious effects than quinine. The effects of the former are known 
and visible to all; it is therefore given with caution. The latter, 
under the misguided notion of its tonic and stimulant properties, is 
administered in the most improper cases; while all its pernicious ef- 
fects are reckoned only so many symptoms of a disease, which it is 
most unquestionably to cure. The more alarming these symptoms 
are, the more the pernicious article is pressed upon the patient, ag- 
gravating every alarming symptom, until the unfortunate victim is 
pressed into the grave; the price of being cured secundum artem by- 
quinine! I have often been called to see patients whose case was 
considered hopeless, where the disease was protracted into that state 
solely by the use of quinine, and where the only important indication 
towards effecting a cure was the discontinuance of the medicine. I 
have seen physicians use the sul. quinise, without any fixed rule, or 
any definite views relative to its modus operandi, in ail cases and in 
all stages and varieties of fever indiscriminately, like a charm or en- 
chanted dose, which is to adapt itself to every peculiarity of case, 
and to effect wonders they know not how. Even in this manner it 
cannot always fail. Some cases will happen to be proper, and the 
effects favourable. This will cause it to be given again in twenty 
improper cases. So egregiously are its pernicious effects overlooked 
or misconceived, that not unfrequently the most decided evidence of 
its pernicious effects, such as tinnitus aurium, deafness, vertigo, 
strabismus, cephalalgia, nausea, and vomiting, are construed into 
criteria for its administration, and as indicative of its salutary effects. 
Effects these, which I do not hesitate to denounce, as certain indica- 
tions of its improper use, either as relates to the case, or the quantity 
administered. 

The sulphate of quinine, I repeat, is a valuable febrifuge and 
counter-stimulant, and is not in any sense a tonic. Yet its febrifuge 
effects may be obtained without injury from its counter-stimulant 
properties, even in slight cases of asthenic fever, or its action may 
be so modified by a judicous combination of aromatic stimulants and 
opiates, that in cases of moderate asthenia, no detriment will be sua- 



Monett on Quinine on Febrile Affections. 37 

tained from it contra-stimulant properties. In this respect it bears 
a strong reverse analogy with camphor. The quinine being contra- 
stimulant, requires its action to be guarded by capsicum, camphor, and 
opium. Camphor, on the other hand, being stimulant, requires the 
addition of antimonials and other contra-stimulant diaphoretics, to 
adapt it to cases in which it would otherwise be inadmissible. How- 
ever, quinine should not be used in any manner in simple debility un- 
attended with fever. The danger lies in administering quinine in 
cases attended with a cool, relaxed skin, and general diminution of 
tone and action. There must be febrile action, or quinine is injurious 
under any combination. 

It may be laid down as a general rule, to which there will be but 
few exceptions, that the sul. quiniae, as a remedy, is admissible only 
in persons of strong athletic habits, of sanguineous or bilious tem- 
peraments, and whose systems are not debilitated by previous pro- 
tracted disease, and in those who are temperate and free from any 
constitutional irritability. Diseases supervening upon such constitu- 
tions and habits, will be mostly those of direct excitement, and which 
may in some stage be treated with quinine. The quinine, however, 
is contra-indicated in all individuals of lax fibre, and feeble circula- 
tion! in leucophlegmatic and nervous temperaments,* attended with 
torpor in the absorbent system, and with adipose depositions. In 
these constitutions and habits, diseases usually in this latitude assume 
the asthenic character, especially summer and autumnal fevers, and 
constitutional derangements consequent upon them. 

It may not be superfluous to be more particular in specifying those 
diseases in which the sulphate of quinine is pernicious. They are 
chronic debility from whatever cause; want of tone in the ultimate 
fibre, with defective energy, mental and corporeal; disorders conse- 
cutive of weak or irregular, defective or increased action in the abdo- 
minal viscera. The external evidences of such cases are pale skin, 
sallow complexion; feeble and quick pulse, or weak and sluggish; 
pale or ash-coloured tongue, not furred; clear white sclerotica; mental 
lethargy, and aversion to bodily exertion; irregular biliary discharges, 
sometimes deficient, often profuse, thin and yellow: in extreme cases 
of irritable debility, there is a tendency to syncope in a sitting or 
erect posture, throbbing in the head, tinnitus aurium, palpitation and 
vertigo. Quinine aggravates every one of these symptoms. It is 

* M. Bland, in the summer of 1825, observed deafness and other symptoms 
of cerebral congestion, &c. produced by large doses of quinine. This he ob- 
served chiefly in persons of tall and slender make, and of nervous temperaments.— 
JLmer. Journ. of Med. Sciences, No. II. 



38 Monett on Quinine in Febrile Affections. 

improper in violent congestive fever, with cerebral congestion, and 
in the collapsed stage of common, remittent, malignant, and typhu3 
fevers. In any and all cases of these, quinine, as it is generally ad- 
ministered, never fails, even in small doses, to induce a quicker and 
more irritable pulse, thirst, and cerebral congestion, and a train of 
unfavourable symptoms. These, which are aggravated by each dose 
of quinine, are readily relieved by wine or toddy, aromatic cordials, 
camphor, ammonia, and opiates. 

Another disease, whose course has been most terrific in our own 
country, as well as elsewhere, is rapidly hurried on in its fatal ter- 
mination by quinine. Those who have contracted a partiality for 
this article, have naturally enough conceived it peculiarly adapted to 
the cure of malignant cholera, (cholera asphyxia.) The cholera has 
uniformly exhibited the character and symptoms of a most malignant 
collapsed fever, and has always in my opinion required a liberal exhibi- 
tion of aromatic stimulants, camphor, aether, and calomel. The most 
successful have been calomel, opium, camphor, and capsicum. If these 
articles be beneficial in their operation, and if quinine be a contra- 
stimulus, as it undoubtedly is, the impropriety of its use in this dis- 
ease, however guarded by other combinations, is evident. 

In the common congestive summer and autumnal fevers of this coun- 
try, we are presented with an imperfect circulation; abdominal and 
thoracic congestions; pale, relaxed, and cold skin, sometimes covered 
with profuse cold sweat; pulse small, and almost imperceptible; cold 
extremities; impaired sensibility, and a general derangement of all 
the secernant functions. The vital energies are defective, or are at 
once depressed by the force of disease below the point of reaction; 
the whole system is, in fact, in a stage of collapse, from which nothing 
can rouse it, but the prompt use of the most powerful stimuli inter- 
nally and externally. It is in fevers of this character, that quinine 
is too often freely used, under the erroneous impression that it is a 
stimulant and tonic. It only makes the fatal catastrophe more cer- 
tain. If quinine, under any circumstance, be capable of removing 
congestion, it is only in vigorous constitutions, where the circulation 
is only partially oppressed, and where the external heat is not re- 
duced below a normal state. 

There are other cases likewise, in which quinine is pernicious. 
One is that peculiarly irritable and debilitated state of the whole 
animal functions most common in females, designated by the term 
anemia, (parops haematosis.) In cases of this kind, where corrobo- 
rants and generous diet are essentially necessary, the judicious phy- 
sician cannot administer quinine without speedily perceiving its per- 



Monett on Quinine in Febrile Affections, 39 

nicious tendency. In gangrene the sul. quiniae is highly pernicious. 
I should not have supposed it necessary to name this as an improper 
case for quinine, had I not seen it recommended as a substitute for 
bark and wine in gangrenous inflammation in a most respectable 
work on surgery.* I do decidedly believe there is no disease in the 
whole range of nosology, in which the use of this article would be 
more pernicious than in extensive gangrenous inflammation. 

I shall now make a few remarks relative to the use of quinine in 
those cases in which it is a safe and salutary remedy, especially in 
remittent and intermittent fevers; also a few remarks relative to its 
use in synochus fevers, or those which occur mostly during winter 
and spring. 

1st. Remittent fever. — In fevers of this class, with regular remis- 
sions and exacerbations, strong vascular action, and in sound consti- 
tutions and sanguineous temperaments, after the necessary depletion 
and evacuation, the quinine will generally prove a valuable remedy. 
But until the excitement is in some degree reduced, and all offend- 
ing matters removed from the primse vise, it is inadmissible. After 
this preparation, if the arterial excitement continue, the surface be 
dry, and above a healthy temperature, without any strong local de- 
termination, or active inflammation, and where the secretions, if ob- 
structed, are so from over-excitement, the tongue coated with & moist 
white or brown fur, quinine may be given in full and frequent doses. 
In these cases the effects of the quinine may be much promoted by 
combining it with the pulv. ipecac, c. or pulv. ant. or nit. pot. as in 
the subjoined formulas;! to either of which calomel may be added, 
where there is defective secretion from the liver. In children, and 
in females of delicate constitutions, the quinine may be differently 
combined and exhibited. £ In cases of remittent fever it is of parti- 

* Principles of Surgery. By James Syme, F. R. S. E. 8cc. 

f R. Sul. quiniae 9ss. 

Pulv. ant. T)ij. 

Nit. pot. ^ Bij. 

M. ft. pulv. a^q. No. 5. — Unum quaque hora tertia sumend. 
Vel. 

R. Sul. quiniae „„_ ^ss. 

Pulv. Ip. comp J)ij. 

M. ft. pulv. aeq. No. 5, — Un. quaq. hora. tertia sumend. in aliquo vehiculo. 

* R. Spt. aeth. nit. - fgss. 

Aq. font. f^ss. 

Sul. quiniae 9J. 

Vin. ant., elix. paregoric, and tine, digital, aa - fgij. 
M. ft. mist, dose, f^j.; ij. for adult. 



40 Monett on Quinine in Febrile Affections. 

cular importance, that it should be administered previous to the re- 
missions, it may be exhibited also during a remission, provided there 
be no tendency at such time towards prostration or collapse. In this 
manner the excitement of fever is more effectually controlled. But 
the quinine should be carefully withheld during collapse, or a ten- 
dency to it. 

But it is necessary in treating these fevers to discriminate between 
those of an asthenic diathesis with irritable excitement, and those 
with increased force of vascular action. An error in judgment here 
produces a dangerous error in practice. As before observed, a large 
proportion of our summer and autumnal fevers are the result of the 
relaxing influence of protracted heat engendered in asthenic diathesis. 
Of this kind are those generally denominated, and which are really 
bilious fevers attended with an increased secretion and discharge of 
yellow bile, quick, irritable pulse, and excessive head-ache. The 
irritable state of the liver, and the drain through its increased dis- 
charges, tend to exhaust the vital forces to the extreme. In such 
cases, anodyne febrifuges, brandy toddy and opiates, are by far the 
most salutary remedies. Active counter-stimulant remedies tend 
further to impair the tone of the general system, and thereby to ag- 
gravate every symptom. Of all improper remedies, in such cases, I 
know none more pernicious than calomel and quinine. 

In many of the milder cases of congestive fever, where the circula- 
tion is oppressed, but where the collapse is not complete, the quinine 
may be used with benefit, by correcting its contra-stimulant proper- 
ties with camphor and aromatics. These are cases only where the 
heat of the surface is not below a healthy grade, and where no great 
cerebral or gastric disturbance exists. In such the quinine may be 
exhibited in the usual doses, combined as in the formulae below;* 
and where the biliary secretion is defective calomel will be an indis- 
pensable auxiliary. Thus combined, the febrile action is reduced, 
the strength sustained, and the secretions opened, and the circulation 
developed. The same formulae may be used beneficially in the latter 

* R. Sul. quinine 9ss. 

Camph. p. vel. capsici, p. grs. ij. 

Submur. hydr. - - - - - - 9ij. 

M. ft. pulv. xq. No. 5.— Unum quaque hora tertia. S. 

Vel. 

R. Sul. quinize ------- ^ss. 

Camph. pulv. - grs. vj. 

Submur. hydr. ^ij. 

Oxyd. ant. cum. phos. calc. - - - - 9j. 
M. ft. pulv. zeq. No. 5.— Unum quaque hora tertia. S. 



Monett on Quinine in Febrile Affections. 41 

stages of some cases of typhus fever, where the exhaustion or col- 
lapse is moderate. In simple febrile asthenia, of convalescence 
from summer and autumnal fever, quinine if administered, should 
be given in a little porter or wine and water. But in convalescence 
unattended with febrile action, quinine is unnecessary, and even 
pernicious. In such cases porter and wine are the best tonics. 

There has been a great diversity of opinion among physicians re- 
lative to the proper dose of quinine. By some it is given in doses 
of from three to ten grains, and too often in every stage and variety 
of fever. My own opinion, formed from my experience, is, that a 
larger dose than three grains is never necessary; and frequently one 
or two grains, repeated every two or three hours will produce a more 
salutary effect than three. In any case of fever, wherein three 
grains will not produce a salutary effect, it may be taken for granted 
that ten will not. Something else is necessary. But whenever the 
quinine in any case produces tinnitus aurium, deafness, vertigo, 
and vomiting, be the dose what it may, it is too large, and is de- 
cidedly productive of injury: of course it should be discontinued. 

2d. Intermit tents. — The administration of this article in intermit- 
tent fevers, requires an observance of the same rules and principles 
which regulate the use of it in remittent and continued fevers. In- 
termittents are attended by the same diversity of condition of pulse 
and constitutional tone which attend other fevers, these are in one 
class of cases the languid and feeble pulse, pale skin, mental imbe- 
cility, tumefied abdominal viscera, leuco-phlegmatic temperament, 
and other signs of irregular or defective action; in. the other, athletic 
constitutions, sanguineous temperaments, and all the signs of healthy 
vigorous action. Each requires a different plan of treatment. In 
the former the bark in substance, wine, aromatics, opiates, camphor, 
and chalybeates are requisite. Quinine may be used likewise, espe- 
cially if combined with aromatic stimulants and opium, as in the 
subjoined formulas.* One of the pills may be taken every hour, or 

* R. Sul. quiniae 9j. 

Capsici. bacc. p. 9j. 

Opii. pulv. grs. vj. 

Extr. gent. lut. ^iss. 

M. ft. pil. *q. No. 15. 

Vel. 

R. Sul. quiniae ^ss. 

Capsici. bacc. p. ^ss. 

Camph. p 9 SS * 

Extr. gent. lut. 9j. 

M. ft. pil. aq. No. 10. 
No. XXV.— Nov. 1833. 5 



42 Monett on Quinine in Febrile Affections. 

every two hour9, for five or six doses immediately preceding a pa* 
roxysm. In this manner, they seldom fail to effect a speedy cure. 
In the latter, quinine judiciously combined with antimonials and 
opiates, will be the best remedy. The proportion of each article may 
be varied so as to adapt it to any individual peculiarities. This must 
be determined by the judgment of the physician relative to the case 
and the peculiar attending circumstances. 

3d. Synochus. — Fevers of this character are very common here 
during the winter and spring season, and generally have more or 
less partial local determination, but not amounting to absolute inflam- 
mation. In many cases of this kind, after the usual evacuants, the 
sulphate of quinine may be used advantageously by combining it with 
calomel, opium, or antimonial powder, as the case and constitutional 
peculiarities may demand. Where there is some constitutional irri- 
tability, and especially if the bowels are in an irritable condition, 
the quantity of opium may be increased. When the heat of the sur- 
face is above natural, the proportion of antimonial powder may be 
increased. The following formulas are excellent.* In all cases and 
states of synochus fever, in which antimonials, nitre, digitalis, or 
hyosciamus might be admissible, quinine may be used with every ex- 
pectation of benefit: and often where even any one of these may not 
be admissible, the quinine will be productive of salutary effects. But 
particularly in those cases of synochus, in summer or winter, i 
which the bowels are irritable with serous alvine discharges, nothing 
is better than calomel, quinine, opium and camphor. 

For the purpose of further illustrating the principles herein set 
forth, I have selected the following cases from my case-book. 

Case I. Mrs. A. W., Get. 24, of lymphatic temperament; short, 
but not robust stature; muscles covered with a full deposition of soft 
inelastic cellular substance. Soon after the birth of her second child, 
in an easy labour, she fell into a low state of health; her skin became 
exceedingly pale, and almost semitransparent; debility extreme; pulse 

* R. Sul. quinize 9j. 

Pulv. ant. 9'j* 

Opii. pulv. grs. 5. 

M. ft. pulv. aeq. No. x. 

Vel. 

R. Sul. quin. £j. 

Aq. font. f^iv. 

Acid, sulph. dil. fl^xy. 

Tine, opii f3'iss. 

M. ft. solutio, dosefjj. — ij. 



Monett on Quinine in Febrile Affections. 43 

feeble and quick, 120 pulsations in a minute; throbbing of the tem- 
poral arteries, especially on raising the head; impaired digestion, and 
defective sanguification ; tongue extremely pale; mental and corporeal 
languor; bowels soluble. For this state of things I had administered 
a variety of remedies, chiefly chalybeates, opiates, and mineral acids; 
the latter externally and internally. ' The case being tedious, my 
friend Dr. M'Pheeters was called in consultation. Upon his recom- 
mendation, the sulphate of quinine was given in doses of four or five 
grains, three times per day, for two days. But it aggravated all the 
previous symptoms to such a distressing degree, that we were com- 
pelled to abandon it altogether in her case. Other remedies were 
resorted to; and after a tedious and at one time hopeless illness of 
several months, she finally recovered. This was the first case in 
which I perceived the pernicious effects of quinine in cases of debility, 
and in such a constitution. 

Case II. Mr. G. 0. L., set. 19, lymphatic temperament; full, soft, 
rotundity of habit, with muscles soft and flaccid. He was attacked 
June 29th, 1831, with severe bilious fever, with quick, full, weak, and 
irritable pulse. Blood-letting was used pretty freely on the second and 
fourth day of his illness; purgatives and the usual evacuants were 
used. The case became protracted into an irritable remittent with 
diurnal exacerbations, pulse 90 to 120 per minute. In this condition 
I administered the sulphate of quinine, especially during the apy- 
rexia, believing it a tonic. It immediately aggravated all the un- 
favourable symptoms, such as throbbing in the carotids, tinnitus 
aurium, accelerated irritable pulse, nausea, vomiting, &c. Not 
knowing at that time the exact properties of the quinine, I perse- 
vered in its use for several days under various circumstances, in hope 
of subduing the irritable excitement by its tonic stimulant properties. 
But nothing would so modify its effects as to render it admissible, 
and it was reluctantly abandoned for porter, claret sangaree, &c. by 
which a cure was effected. 

Remarks. — In this case, most probably the blood-letting was a dis- 
advantage, and instead of arresting the fever in the first stage, it 
augmented the subsequent debility and irritability of the general 
system; and this was further aggravated by the improper use of qui- 
nine. His temperament too was as I have since learned, unfavourable 
for quinine in almost any case. 

Case III. Mrs. D. S. set. 27, leuco-phlegmatic temperament, 
rather tall, somewhat full habit when in health; mother of three chil- 
dren. For twelve months previous to my visit, she had been in bad 
health, and supposed to be labouring under hepatic disease; she had 



44 Monett on Quinine in Febrile Affections. 

been under the care of several physicians in her vicinity. When I 
first saw her, she was exceedingly feeble, pale and sallow, with a 
low, irritable febricula, pulse 100 to 110 per minute, and very feeble; 
palms of the hands and soles of the feet dry and hot, with a burning 
sensation; bowels were torpid, but were occasionally lax, with yellow, 
thin, bilious discharges, and often accompanied with distressing te- 
nesmus, uneasy sensation in the right hypochondrium. In this situa- 
tion she was unable to sit up in bed more than five minutes at once, 
on account of throbbing in the head, palpitation, and other symptoms 
of irritable debility. In this state she had been taking pulv. ipecac, 
comp. ; nit. potassse; sul. quiniae; Seidlitz powders, and other medi- 
cines calculated to reduce sthenic excitement; all of which were de- 
cidedly injurious, especially the quinine which was given under the 
belief of its powerful tonic properties. The rapid aggravation of all 
those symptoms by the last article, during the last few days, produced 
the alarm which caused me to be called to see her entirely out of my 
neighbourhood. Yet neither her friends nor her physician had sus- 
pected the quinine, for it was considered a valuable tonic, and just 
such as she required, but with it was enforced a strict antiphlogistic 
regimen! I directly changed the whole course, proscribed quinine, 
and gave wine, porter, chalybeates, and opiates; ordered a light ge- 
nerous diet, daily friction of the surface with a strong liniment. 
Under this plan, modified to suit circumstances, she rapidly improved, 
and in ten or fifteen days was able to sit on horseback. 

Remarks. — I do not hesitate to say, that I believe, if the quinine 
and other contra-stimulants had been continued a few days more, 
her mortal existence would then have been terminated. The extreme 
debility and irritability were such, that her system must unquestion- 
ably have yielded. Whenever these had been aggravated by the 
quinine, the onus morbi seemed to fall immediately upon the brain 
and liver, and attended with copious bilious discharges. 

Case IV. Mr. D. D. G.,eet. 40, nervoso-lymphatic temperament, 
full habit, inclining to obesity; flaccid muscular fibre. In September, 
1832, he was attacked severely with bilious fever. He was depleted 
freely and carried through a severe mercurial treatment before I saw 
him, at which time he was very much debilitated. During the periods 
of remission in his fever, he had attempted to take quinine in doses 
of three or four grains, as well as in smaller doses; but invariably 
with pernicious effects. His physician having persevered in his at- 
tempts with this medicine for several days, under the belief of its 
febrifuge and tonic properties, was at length compelled to abandon 
it entirely in this case, on account of the distressing nausea, head- 



Monett on Quinine in Febrile Affections. 45 

ache, throbbing of the carotids and tinnitus aurium, which it uniform- 
ly produced. Wine-toddy, and anodynes were substituted with the 
happiest effects, and under their use he rapidly recovered. 

Remarks. — I feel certain, that had the use of quinine with this 
patient been persevered in to the extent prescribed by many practi- 
tioners, this man would have fallen a victim to its use, and a martyr 
to preconceived opinions; or at least he would have been thrown into 
a protracted debility and febricula, and his final recovery doubtful. 

Case V. Mrs. W., set. 45, of leuco-phlegmatic temperament, full, 
corpulent habit, and lax fibre; frame rather large. This lady had 
been severely attacked with bilious remittent fever in August, 1832; 
this attack was succeeded by a very feeble and infirm convalescence. 
When I first saw her about the middle of September following, she 
was labouring under the effects of an imperfect tertian intermittent; 
her countenance was pale and occasionally bloated; extremities 
slightly oedematous; pulse feeble and small; bowels dysenteric, and 
aggravated by severe tenesmus during each paroxysm of her fever; 
great dejection of spirits continually; mental lethargy and imbecility; 
tongue clean, smooth and pale. During each paroxysm of her inter- 
mittent, she was oppressed with extreme languor and debility, so 
much so that it was feared she could not survive one or at furthest 
two more. The family physician had been pursuing an active course 
of mercurial purgatives, with the. desire of placing her under the con- 
stitutional influence of mercury, and during the last few days he had 
been making a free exhibition of the sul. quiniae, on account of tbe 
intermittent character her disease had assumed. Every dose of this 
last medicine had aggravated all the symptoms of irritable debility, 
and the throbbing of the carotids, tinnitus aurium, faintness when 
the head was erect, nausea and vomiting had become distressing, 
and extremely alarming. Under these circumstances, I was request- 
ed to visit her in consultation. Neither the family nor the physician 
had suspected the pernicious effects of the quinine, although they 
readily admitted that she had been worse during the time she had been 
under its use. But this was attributed to the intractable character of 
her disease, resisting the powers of even this potent medicine. 

The quinine was immediately discontinued, a mild laxative admi- 
nistered, with wine and water as a drink. After the operation of the 
laxative, she was put upon the use of the following pills; viz. — R. 
Caps. p. grs. v, ; opii. p. grs. iij.; camph. p. grs. v. ;extr. gent. Jss.j 
M. ft. pil. aeq. No x. ; taking one every two hours for six hours pre- 
ceding the expected paroxysm of the intermittent. Friction freely, 
wine, light nutritious diet were continued daily. Under this course 

5* 



46 Monett on Quinine in Febrile Affections. 

she improved rapidly; and a few days afterwards, as soon as she was 
sufficiently relieved from the prostration and irritable debility, the 
following was substituted; viz. Phosph. ferri, 9j.; zing. p. 9ss.; M. 
ft. pulv. aeq. No. 4.; one to be taken every five hours. Had this 
patient continued the use of the quinine, she certainly could not have 
survived more than a day or two longer. 

Case VI. Mrs. M. aet. 35, of lymphatic temperament, large frame, 
muscles covered with a thick deposition of cellular substance. She 
was attacked in September, 1831, with a bilious remittent fever. 
About the seventh day of her illness I was called to see her in con- 
sultation. She had been bled, and freely evacuated; and for three 
days previous to my visit, had been taking quinine quite freely, having 
began with it at the first indication of a remission. The symptoms 
were such now as excited considerable alarm, the original remittent 
had left her, but she was labouring under the most distressing irri- 
table excitement, nausea, and continual vomiting, and vertigo; all 
which were caused and kept up by the quinine. A blister had been 
applied to the epigastrium to relieve the gastric irritation, but without 
effect, so long as the quinine was administered. I immediately dis- 
continued the sul. quiniae, and gave a few portions of the julep of 
carb. ammon. and paregoric. Every unfavourable symptom disap- 
peared almost instantaneously, and convalescence proceeded rapidly 
to perfect health, without any other medicine. 

Case VII. C. B. set. 22, of lymphatic, or leuco-phlegmatic tem- 
perament; tall and slim; feeble in physical and mental energy. In 
October, 1832, he had complained of debility and an imperfectly de- 
veloped intermittent, but still continued to attend to his ordinary 
business of keeping store. In this state, after a purgative, he took 
very freely of a strong solution of sul. quiniae. He had been taking 
it only twenty-four hours when I was called in haste to visit him, as 
he was thought to be dying. The distance being only one or two hun- 
dred yards, I saw him immediately, and found him in bed, pale and ex- 
tremely feeble, disposed to faint whenever his head was raised from 
the pillow; pulse languid and feeble. I immediately administered a 
dose or two of aqua ammoniae and tine, cam ph. in a little brandy- 
toddy. This almost instantly relieved his distress, and by repeating 
it every two or three hours for one or two days, he was entirely re- 
lieved. During these two days, whenever he omitted the dose too 
long, the same symptoms as before began to recur, so much was his 
system under the action of the excessive doses of quinine. 

Case VIII. Miss M. K. aet. 9, a child of delicate constitution, 
of nervo-lymphatic temperament, and light hair. In the latter part 



Monett on Quinine in Febrile Affections. 47 

of September, 1 832, she had a severe attack of autumnal remittent 
fever, from which her recovery was slow, with frequent relapses. 
When I saw her towards the latter part of October, in consultation, 
I found her skin pale, abdomen tumid, with constant slow fever, 
which seemed to have been kept up by a sub-acute inflammation of 
the bowels, together with an enlarged spleen and tumefied liver. For 
several days she had been using the quinine, which had been observed 
to quicken the pulse, and to excite an irritable fever, with great 
anxiety. I advised the discontinuance of the quinine, and the use 
of wine, opiates, and chalybeates combined. A blister had been ap- 
plied to the epigastrium. I had the pleasure to find that she improved 
under this course, and was soon restored to health. 

These few cases I have selected to illustrate the pernicious eiFects 
resulting from an improper use of this valuable article. Many more 
might be given; but being unwilling to protract this paper unneces- 
sarily, I have selected these as embracing all that might be contained 
in any greater number of cases. 

To show that the properties and effects of quinine, as herein set 
forth, have not entirely escaped the observation of practitioners, I 
will cite the authority of a few writers in Europe, as well as in the 
United States. Although they possessed a partial knowledge of its 
effects in certain cases, they by no means understood correctly its 
precise medicinal properties. As we noted in the former part of this 
paper, M. Bally considered it " more irritating than the sulphate of 
cinchonia." This is the result of its peculiar property of diminishing 
the tone and increasing the irritability of the system in debilitated 
cases, in which the sulph. cinchoniae would be proper, or at least pre- 
ferable to quinine. Dr. Gunther,* of Cologne, in 1825 recom- 
mended a combination of quinine and digitalis in phthisis pulmonalis, 
in the quantity of two or three grains of the former, and half a grain 
of the latter every three or four hours. This combination would, 
doubtless, be salutary in febrile or inflammatory cases, and in tonic 
diatheses. In such, the action of the two articles would be perfectly 
compatible. M. Vulpes,! of Naples, states that in a very fatal 
asthenic fever, which came under his care, having broken out among 
a number of invalids, crowded together in a convent, the sul. quiniae 
could not be used safely. This fever, at first being considered of an 
inflammatory character, was treated antiphlogistically, and with ill 
success. Next supposing it to be asthenic, it was treated with sulph. 

* See American Journal of Medical Sciences, No. IX. p. 214. 
f Vide Revue Medicale, May, 1828. 



48 Monett on Quinine in Febrile Affections. 

quiniae, erroneously considered as a powerful tonic. But this aggra- 
vated every symptom; being even more pernicious than the antiphlo- 
gistic plan. The cinchona, (quinquina,) a real tonic, was next used 
with the happiest effects. This is a case fairly in point, where the 
quinine was demonstrated to be improper in asthenic states of the 
system, and vice versa. M. Vulpes further confirms the principles 
herein set forth. He contends that the quinine is anti-febrile, and is 
different in its properties from the bark; the latter being tonic, the 
other not. Dr. Harty,* of Dublin, states that the sulph. quinise pos- 
sesses the property of accelerating mercurial action, similar to that 
of tartarized antimony. It produces this result by diminishing the 
tone and excitement to the mercurial point. The same may be ob- 
tained by blood-letting, antimonials, nitre, digitalis, &c. 

I now proceed to cite authority in our own country. Here all 
written authority, so far as I am acquainted, is in direct opposition 
to some of the principles laid down in this paper. Yet, from even 
such testimony I shall adduce sufficient evidence to confirm the 
principles contained in this paper. 

1. In the " Western Journal of the Medical and Physical Sciences, 
for October, 1829, is an essay on the autumnal fevers of Georgia, 
by James C. Finley, M. D." The author, after speaking favourably 
of the sulph. quin. as a tonic in these fevers, adds, "I have certainly 
seen very serious inconvenience follow its administration, even when 
there was a perfect intermission of twelve hours, with a soft pulse, and 
a general relaxation of the surface. Some caution is undoubtedly 
necessary, therefore, in resorting to it." (Vide page 190.) Cases of 
this character, which are doubtless frequent in the low lands of 
Georgia, are those in which we have shown the quinine to be de- 
cidedly pernicious. For quinine, always improper in relaxed and 
asthenic fevers, is especially so during their remission. Here the 
doctor, although the fact could not escape his close observation, 
seems to consider this an anomaly in the effects of quinine. Being 
unacquainted with its precise medicinal properties, he has conse- 
quently reasoned erroneously relative to its effects. But in these 
and other irritable cases, where quinine is injurious, he very correctly 
recommends as antidotes and substitutes, opiate anodynes, ammonia, 
wine, &c. Thus far his experience coincides with mine; and upon 
the whole, his few remarks relative- to the use of quinine in his paper 
are more judicious than any I have seen. But he evidently was not 
apprised of its constant pernicious effects in relaxed asthenic and 

* See Edin. Med. and Surg. Journ. for October, 1829. 



Monett on Quinine in Febrile Affections. 49 

congestive cases, for in the July No. of the same Journal, for 1830,* 
we see him using it in the most improper cases. For the sake of 
brevity, I beg leave to refer the reader's attentive observation to the 
first, second, third, fourth, and seventh cases as there recorded, and 
to examine and analyze them by the principles contained in this 
paper. 

2. Again, I refer the reader to a paper by Dr. John H. Savage, 
on the fevers of Mississippi, published in the Transylvania Journal 
for March, 1831. t He believes the sulph. quiniae a powerful tonic and 
stimulant, and to this belief the most stubborn facts must bend. He 
states that it speedily converts congestion into inflammation, accom- 
panied with general tonic inflammatory reaction, and hence infers 
the impropriety of its use in congestive fevers. If such were its 
properties, what would be its effects in those cases of open fever 
and tonic action in which he recommends its use? That which 
he takes for inflammation and reaction, is only so many evidences 
of that peculiar irritable state of the arterial and nervous sys- 
tems, which is produced by the contra-stimulant properties of qui- 
nine in improper cases. He says, " in all cases of congestive fever, 
the brain, as has been before remarked, suffers from vascular engorge- 
ment; and it is in this variety that the sulphate of quina displays its 
most pernicious, and frequently fatal effects." These fatal effects 
result from increased irritability of the brain and nervous system, and 
not from inflammation as he supposes. 

3. Finally, I refer to a paper on the autumnal remittent fevers 
of Alabama, by J. W. Heustis, M. D. in the No. of this Journal 
for February, 1832, for several facts confirmative of my principles, 
though the author, who believes quinine to be a tonic and stimulant, 
views them differently. 

Before closing this paper, I will make one remark relative to the 
cuticular introduction of the sulph. quiniae. I have known this article 
to be applied extensively to the skin by friction, even in fatal gastro- 
enteritic fever! A more egregious folly was never committed by man. 
The introduction of quinine by denuding the surface with epispastics, 
has been highly recommended by M. de Martin,^ Professor Spe- 
ranza, and others, in the cure of those intermittents wherein its in- 
ternal use cannot be tolerated. They seem determined that patients 
shall not recover, without having endured the effects of this drug in 
some manner or other. But the high authority of even great names 
cannot possibly divest this practice of its absurdity. I insist upon 

* See pp. 40, 41, 42, 43, 44. f See pp. 31, 32, 33 t 34. 

* Revue Medicale, September, 1827. 



50 Monett on Quinine in Febrile Affections. 

it, that its use externally, even if absorbed by the skin, cannot be 
otherwise than prejudicial in those cases where its use internally is 
impracticable. M. de Martin, himself, states that when quinine in 
dry powder is applied immediately to a denuded surface, it produces 
a black slough — gangrene, by directly diminishing the vitality in such 
part; yet he persists in its use, and to prevent this effect, as if it were 
a calamity for a patient to recover without quinine, he mixes it in 
cerate. By this means the exposed surface is protected from its 
action and its consequent effects, whether good or bad. Yet so par- 
tial is he to this medicine, that he ascribes salutary effects to it, even 
under these circumstances. Unfortunately, the human mind is prone 
to enthusiasm, even when most enlightened, and in no pursuit more 
than in medical science and practice, where too often the unfortunate 
patient, after suffering more than death, pays with his life the price 
of his physician's enthusiasm. In cases of intermittent fever, where 
the cure is ascribed to quinine applied externally to a denuded sur- 
face, the cure is, in fact, attributable to the vesicatory, and not to 
the quinine. With me it is not uncommon, in protracted intermit- 
tents, when other remedies have failed, to complete the cure by 
epispastics to the extremities and elsewhere, with all the certainty 
which has been ascribed to the external application of quinine to a 
blistered surface. 

It may not be improper to add a few remarks relative to some of 
the combinations of quinine in practice. 

1, With calomel. — No doubt the action of calomel in a certain 
class of cases is promoted greatly by the addition of quinine. But 
this effect is obtained only when judiciously employed. In many 
other cases calomel, itself improper, is rendered doubly pernicious 
by the addition of quinine. These last are cases of debility and in- 
creased nervous irritability, with morbidly increased secretion from 
the liver. The former are those of sthenic fever, without any great 
local determination, or any increased organic sensibility. Calomel 
and quinine, with or without pulv. ant. rnd opium, is admirably 
adapted to ardent summer and autumnal fevers, attended with serous 
or watery discharges from the bowels, and where at the same time 
the surface is hot, the tongue soft and moist. It is very applicable 
to cholera infantum in the incipient febrile state. The quinine tends 
to reduce the inordinate general action down to the secreting point, 
while the calomel is thereby enabled to produce a more immediate 
impression upon the defective secreting functions. In bilious and 
other fevers of debility, especially in persons whose constitutions are 
impaired by imtemperance or otherwise, quinine is decidedly inju- 



Monett on Quinine in Febrile Affections. 51 

rious, by increasing the debility, and adding to the attendant consti- 
tutional irritability. In this variety of cases, calomel too is perni- 
cious, acting as a general and local irritant. But in ardent fevers of 
whatever character, in the first stages of even scarlatina anginosa, 
the combination of calomel and quinine is highly useful. 

2. With nit. potassa. — This combination is adapted particularly to 
ardent fevers with great excitement, or in fevers atttended with mo- 
derate action and unimpaired constitutional vigour, but with hot, dry 
skin, and soft, coated tongue. The quinine and nitre act in union, 
and are perfectly compatible in those cases in which either are proper. 
Both are pernicious in asthenic fevers, and in simple asthenia. The 
pulv. ipecac, comp. is an excellent combination with quinine, and 
in many cases will supercede the nit. potassa, especially in the first 
stages of those fevers which occur in winter, of synochus character. 

3. With spt. xth. nitro si. -*-The spt. of nitre differs from the nit. 
potassa in its properties, and possesses slightly stimulating febrifuge 
properties. In cases of fever in delicate constitutions, and in chil- 
dren, this property of the spt. of nitre is well adapted to a combina- 
tion with quinine. By this means the violent action of the quinine, 
as a counter-stimulant, is in some degree guarded, while its febrifuge 
properties are not impaired. This combination is more efficacious 
with a portion of tinct. opii camph. 

4. With antimonials. — The pulv. ant. is preferable to ant. tart, 
and is proper in all those cases where the nit. potassa may be com- 
bined with advantage. The golden sulphuret of antimony with cam- 
phor, is an excellent addition to quinine in low cases of fever of a 
typhoid type. This combination produces an excellent effect as a 
stimulating febrifuge and sudorific. 

5. With camphor. — Camphor is one of the antidotes to the effects 
produced by an excessive dose of quinine. In cases where the contra- 
stimulant effects of quinine alone would be injurious, the addition of 
camphor changes its effects into that of a stimulating febrifuge, and 
adapts its use to cases with oppressed circulation, in which it would 
otherwise be injurious, as in congestive fevers, and also to typhoid 
febricula. It will also be a judicious combination in fevers attend- 
ant upon impaired constitutional tone from intemperance, &c. In 
these last cases it might be used, combined in solution with the com- 
mon camphorated julep. 

6. With opium. — Opium forms an excellent adjuvant and correc- 
tive to the sul. quinise in cases of protracted intermittentsj but in 
cases of remittent and continued fevers, quinine is seldom proper 
where opium is required to counteract its pernicious effects. Some- 



52 Moneit on Quinine in Febrile Affections. 

times, however, there are cases of remittent and continued fever in 
persons of delicate constitutions, or constitutions naturally irritable, 
and unattended with general debility, where quinine and opium exert 
the happiest effects. The opium in such cases counteracts, or allays 
that irritability which the quinine alone would produce. 

7. With digitalis. — In a preceding page we referred to the use of 
quinine with digitalis in phthisis pulmonalis. The digitalis would 
not be given prudently in other than inflammatory cases, or those at- 
tended with fever and arterial excitement. In such, the action of 
quinine is almost identical with digitalis, both tending to reduce the 
force and frequency of the pulse, and open certain secretions. I 
have made trial of this combination in pulmonary inflammation, but 
my experience in that point is too limited to justify much commen- 
dation. I should however give it as my opinion, that such a combi- 
nation might be highly useful, especially with the addition of a small 
quantity of an antimonial and anodyne. But both quinine and di- 
gitalis would be injurious in those cases of phthisis pulmonalis grow- 
ing out of debilitated constitutions and hereditary scrofulous habits. 

With these remarks I close this paper. The principles contained 
are mostly new, and so far as I am acquainted, differ materially from 
those entertained by the profession generally. As confirmed by my 
experience, they may be summed up in the following conclusions, viz. 

1. That the sulphate of quinine is not properly a substitute for the 
Peruvian bark; that its properties and mode of action differ essen- 
tially from those of the bark. 

2. That it is not a tonic, but acts by a property differing, if not 
the reverse; and cannot be given with safety in cases where tonics or 
stimulants are indicated, but the reverse. 

3. That its action in sthenic fevers resembles that of other contra- 
stimulants, by diminishing the force of the circulation, but it in- 
creases the irritability of the circulating and nervous systems in 
feeble constitutions, and in cases of direct debility. 

4. That as a general rule, it is more applicable in sanguineous 
temperaments, and sound constitutions, than in nervous and lympha- 
tic temperaments, or in cases of impaired constitutional vigour. 

5. That it is not applicable in the stage of asphyxia, unless there 
be at such time, an unusual force in the arterial pulsations, and that 
it is decidedly pernicious in low grades of fever, and in every variety 
of fever attended with gastro-enteritis, and dry tongue. 

Washington, Mississippi, February 9,5th, 1833. 



Young's Reports of Cases. 53 



Art. IV. Reports of Cases. By J. Young, M. D. of Chester, 
Delaware County, Pennsylvania. 

CASE I. Effects of lightning. — On the evening of June 14th, 1832, 
the house of Mr. C. Levis was stricken with lightning. One of his 
daughters, aged thirteen, was sitting on a chair in the door-way be- 
tween two adjoining rooms, down the post, or frame of which, a por- 
tion of the electric fluid passed from an upper room; the child and 
chair were thrown several feet, and she fell, and remained senseless 
until I saw her, which was in about an hour after the occurrence. 
When I arrived, a number of neighbours had collected, and in the 
confusion of the moment, they were all calling on me to hurry and 
bleed her. I had never seen a case of the kind before, and had not 
acquired by reading or otherwise, any fixed ideas concerning the 
treatment of such cases; and from the bustle attendant on this case, 
it afforded but slight opportunity for cool reflexion and determination; 
acting however on the surgical maxim, festina lente, while they were 
procuring bandage, &c. for bleeding, a serious doubt arose on the 
propriety of bleeding, under the circumstances attending it. The 
patient appeared to me to be in a situation entirely similar to many 
cases of severe concussion from blows, falls, &c. that I had witnessed. 
She was entirely insensible to every external impression, with deep, 
slow, interrupted respiration; the relaxation of the muscular system 
was complete; the pulse, as to fullness, was nearly natural, it was 
soft, very easily compressible, and very slow, being only about 60, 
as near as could be ascertained by a second watch; the pupil was 
sensible, though fully dilated; I believed to bleed under such circum- 
stances, before reaction took place, would effectually prevent it, and 
instantly resolved to treat it as a case of concussion from any other 
cause, with the exception of dashing cold water on the head with my 
hand, a practice I had somewhere seen, or heard recommended, but 
have forgotten the authority; and I only resorted to it for the sake of 
doing something to satisfy the bystanders and parents, without expect- 
ing much good to result. In this however I was most satisfactorily 
disappointed. In less than half a minute, the patient began to toss 
about and moan for the first time since the accident; by a continuance 
of the dashing for about five minutes, she appeared so much aroused, 
as was evinced by crying, endeavouring to talk, though without being 
able, tossing, and shrinking from the cold, that we discontinued its 
use, had her wet clothes taken off, and had her put to bed and covered 
up warm. After this, she was alternately still, and inclined to doze 
No. XXV. —Nov. 1833. 6 



54 Young's Reports of Cases. 

and sleep for a minute or two at a time, then to roll from side to 
side, moan, and seemed in great distress; the surface was cold, but 
the pulse harder, more frequent and quick; the pupils were con- 
tracted, and every thing indicated a change, approaching to reaction, 
to have taken place; I remained with her till 2 o'clock, A. M. when 
it was established, she could talk and explain her sensations; she 
complained of very severe pain in the head, and I now apprehended 
danger from the opposite quarter, to anticipate which, I bled her to 
twenty ounces by estimate, keeping my finger on the pulse, and 
not stopping till there was a perceptible change in it; her head was 
bathed with cool vinegar, and as her feet were yet cold, they were 
enveloped in wetted horse-radish leaves; in half an hour she sunk 
into a composed, comfortable sleep, from which she did not rouse till 
half-past 7 o'clock. Finding the pulse again too active, and the pa- 
tient still complaining of some head-ache, I again bled her twelve 
ounces, ordered a dose of Epsom salts to be given in three or four 
hours, with some other directions concerning diet, stillness, &c. and 
left her, with a request to be sent for, if it was thought necessary. 
I heard no more form her for a week, when she had almost entirely 
recovered from all the effects of the injury. 

Fortunately, accidents of this kind are not frequent, but still they 
are sufficiently so to render fixed principles in their treatment desira- 
ble. If any thing of the kind exists, I, and perhaps many others, are 
ignorant of where to find them; in fact, I do not recollect reading 
any thing concerning it in any medical work, although elaborate es- 
says may exist; situated in the country, and engaged in the laborious 
occupation of a country practice, we have not the facilities for re- 
ference of city practitioners. If, however, we are justifiable in draw- 
ing conclusive inferences from our case, I believe the correct princi- 
ple to act on, is to wait for reaction before venturing to bleed, and 
to promote the taking place of this by cold water dashed on the head. 
Query? Might not this cold dashing be serviceable in cases of severe 
concussion from falls, blows, &c. when the patient lies for hours, and 
even days before reaction comes on? I have not had an opportunity 
of trying it, since I witnessed its effect in the above case, but I think 
it worth a trial. 

Case II. Gun-shot wound complicated with hum. — Robert Sutter, 
Sept. 25th, 1831, in withdrawing the load from a large horseman's 
pistol, discharged the whole contents through the left hand; he had 
drawn the wad from the shot, and turned the muzzle into his hand to 
receive the shot, but it not running down, he struck the muzzle into 
the palm of the hand to shake it down, when the percussion caused 



Young's Reports of Cases. 55 

it to go oft', and the load passed through the hand. I saw him in an 
hour after, he was pale, and could not sit up without fainting, although 
he had not lost an ounce of blood. The metacarpal bone and the 
flexor and extensor tendons of the finger next the small one were gone 
entirely^ the finger with its connexion to the small one remained, but 
these two fingers were torn laterally from the ring-finger, the meta- 
carpal bone of which was fractured near the middle, as was that of 
the small finger. In the palm of the hand, when the parts were ap- 
proximated, there only appeared a ragged cut running from the mid- 
dle to the roots of the thumb, forefinger, and the small finger; the 
back of the hand was literally torn to pieces. The fractured bones 
and their extensors were denuded, as was the metacarpal bone and 
tendons of the forefinger, the whole two was completely blackened 
with the burnt powder. On first examining it, the only idea that 
occurred to me was, that the hand must be amputated, for it appeared 
entirely improbable, if not impossible, that nature could ever restore 
such a mangled, blackened mass of flesh as it appeared, in such a 
manner as to be of any use to the unfortunate possessor of it. Having 
known some instances however of the wonderful powers of nature in 
restoring lesions, I thought it advisable to defer it, on the grounds 
that it could be done in a few days, if it was found absolutely neces- 
sary, after trying to restore it by proper means. Believing the third 
finger would be worse than useless, without a metacarpal bone or 
tendons, I removed it with a scalpel, (the parts were so benumbed, 
that in doing this, the patient knew nothing of it, until some days 
after he discovered when I was dressing it, that one finger was mis- 
sing;) after this I cleansed the parts as well as I could, drew the 
sides of the small finger and ring-finger together, and retained them 
with adhesive strips; I then drew the lacerated fragments of skin 
together, so as to cover as much of the exposed surfaces as possible, 
and retained them with strips; the ends of the fractured bones were 
placed in apposition, and a piece of sole-leather fitted to the palm of 
the hand; anointed the whole hand well with castor oil, and enveloped 
it in raw cotton. It was not opened till the third day. I was ap- 
prehensive on one hand of tetanus, and on the other of sphacelus; I 
accordingly watched his symptoms with care, sometimes giving lau- 
danum when required, and regulating the bowels, diet, &c. On 
the third day it was dressed, and from its appearance, taken in con- 
nexion with the state of the system, I was encouraged to hope for a 
more favourable termination than I at all anticipated at first view. 
Suppuration had not commenced, but I felt satisfied it would; dres- 
sing, the same as before, and over the external dressing an envelope 



56 . Young's Reports of Cases. 

of thick muslin cloth, to be kept moist with warm water. In two 
days more it was suppurating kindly, and from this time till it was 
entirely healed, not an unpleasant symptom occurred; the fractured 
bones united; the cavity occasioned by the absence of the metacarpal 
bone above referred to, filled up, and on the 31st of October, being 
one month and five days after the accident, I dismissed him cured, 
with a very tolerable hand, at least such a one as he is enabled to 
work at his trade with, that of a shoemaker, and he lately informed 
me, that he " dont know but that he can work as well, and as fast, 
as before it happened." 

This case is only interesting, as it furnishes another example of 
the great powers of nature in restoring complicated lacerations. Had 
I yielded to the first suggestions of my own mind, which were se- 
conded by the popular voice of perhaps twenty individuals who had 
assembled, not one of whom believed it could " ever be cured so as 
to be of any use to him," and amputated the hand for the sake of 
gratifying a little vanity, perhaps it may be called, to which too 
many of us I fear are prone, what an irreparable injury the poor lad 
would have sustained. Instead of being able, as he now will be, to 
support himself reputably by his trade, his only resource would have 
been a miserable subsistence in some of our public Alms-houses. 

As I alluded to amputations above, I will here refer to a case of 
a young man, whose family is prone to scrofulous diseases, who, 
about eight years ago, in getting on a horse, sprained his ankle slight- 
ly; he paid little regard to it at the time, but next day it was swollen 
to the knee, and very much inflamed; his mother used domestic means 
with it for three or four days, when finding she could not relieve it, 
I was requested to see it. On my first visit I found an evident fluc- 
tuation down by the outer side of the tibia; with an abscess lancet I 
opened the tumour, and it discharged more than a pint of thin flocculent 
matter streaked with blood; from that time the patient had hectic fever, 
chills and sweats, with loss of appetite, and rapid emaciation; his leg 
continued to discharge an unhealthy pus, from three openings which 
took place in the course of the tibia within about a month, and finally 
large fleshy granulations were thrown out; on probing it, the bone 
was found rough, and diseased from the ankle, to within two inches 
of the knee-joint. I prescribed tonics, opiates, and nourishing diet 
to keep up his strength, and to restrain a colliquative diarrhoea, 
which had become frequent and troublesome; he at times had too, a 
troublesome cough, with a copious muco-purulent expectoration. The 
case was altogether an hopeless one. This was the first occasion 
upon which I had ever been called into the family. In perhaps six 



Young's Reports of Cases. 57 

months after his accession of his disease, the physician who had for- 
merly attended the family, happened to pass, and hearing of the indis- 
position of the young man, called as a friend to see him; he found 
him bed-ridden, coughing and spitting, his leg discharging, and hectic. 
Under all these circumstances, he insisted on the propriety of ampu- 
tation. He wished to visit the patient in consultation; we met, I 
resisted the amputation, on the ground that if we did amputate he 
would die with consumption of the lungs, and that it was doubtful 
whether the stump would heal on account of the exhausted state of 
the system, and the tendency to scrofula; in short, that if he could 
not be cured without the operation, he could not by it. We met no 
more, I continued in attendance, and after a long struggle, (more 
than a year,) the powers of his system, aided by medicines which 
were varied from time to time, according to the circumstances of the 
case, began to exert themselves successfully, and his cough, diarrhoea, 
and hectic, all disappeared; he got to exercising on crutches, aud the 
disease assumed entirely a local character. On the 20th of October, 
1827, I cut down to, and removed about two-thirds of the whole ca- 
liber of the tibia, which from the epiphysis downward was spongy, and 
like a honeycomb in substance; in a short time this healed up, and 
a new bone has since formed. From that time till the present, occa- 
sional fragments have been detached from the remaining portion, and 
there is yet a small portion to be discharged; but the patient runs about 
on it without crutch or cane, and attends to his occupation; he is the 
son of a farmer, and assists his father in conducting and managing 
the farm. He has repeatedly expressed his satisfaction to me, and 
thanked me for my firmness in resisting the operation, assuring me 
that his leg is far preferable to a stump or a wooden-leg. 

Case III. Chorea sancti viti. — Since my former communication 
in your journal on this disease, I have treated another case of it. A 
brother, aged seventeen, of the young lady whose case is there des- 
cribed, was attacked May 20th, 1832, in one side. His health was 
perfectly good, and no clue as to the seat of the latent irritation 
causing the disease could be ascertained. Without administering 
even a cathartic, or any other medicine, he was put on the use of the 
pulverized root of the Actea racemosa, a tea-spoonful three times a 
day. He was getting worse from day to day before commencing the 
use of it, but it appeared to arrest its progress almost at once. After 
using it only two days he was visibly benefited, and was entirely 
cured in five days. He remains well, and no one of those formerly 
treated with it have had any return. 

6* 



58 Young's Reports of Cases. 

Case IV. Partial congestion of the brain. — Mrs. H. was delivered 
of a dead foetus at the seventh month of gestation, on the 10th of May 
last. Things went on favourably for nine or ten days. The lochia 
ceased suddenly and she was attacked with violent pain in the an- 
terior part of the head; I was called in haste, and on my arrival, 
supposed the pain in the head might be owing to that cause, and pre- 
scribed accordingly; next day the lochia had returned and she was 
much better, and continued so for three days, when I was again 
called in haste to her. I now found her in excessive pain under the 
left parietal protuberance, extending downwards and forwards to the 
ear and eye of the left side, and entirely unable to speak, except in 
monosyllables. She was entirely rational, had the free use of her 
tongue, and appeared to comprehend every thing said to her, but 
could not reply to any thing further than yes, or no, correctly. She 
had not lost the recollection of words, but the power of connecting 
them into sentences; thus, when I asked her where the situation of 
the pain was, she laid her hand on the side of her head, and said 
"its — house — dog— mother," and I stopped her, and asked, have 
you pain in any other part of the head, she said, no; is it very severe? 
yes, she replied. I asked if she had pain in any other part than the 
head, she said, no. But when asked any question that required more 
than one word, as yes, or no, for answer, she ran on with a string of 
entirely disconnected monosyllables till stopped, when sometimes she 
would burst into tears from the consciousness of her inability to make 
herself understood, or to give correct answers. Her bowels were 
rather torpid; tongue clean and natural; the countenance natural; the 
pulse soft, slow and regular; the lochia had again ceased; the stomach 
occasionally nauseated; no thirst. I ordered ten grains of calomel, 
divided in five powders, one every hour, to be carried off with oil; 
warm vinegar, and camphorated vinegar to the head; fomentations 
to the pubes, and pediluvia of salt water; drink pennyroyal or cat- 
mint tea; diet, gruel or panada; entire quietness, the room to be 
kept ventilated, and well shaded. 

Next day she was much as before. When I asked her how are 
you this morning? I received for answer, " I — cant, no, fire, town;" 
I stopped her, and asked, are you any better? she said no. I asked 
a number of questions, to all of which she replied in such disjointed 
sentences, that I did not perceive any change for the better. I or- 
dered a continuance of the same means as yesterday, with a sinapism 
to the neck. 
At my next visit, May 26th, she appeared a little better, inas- 



Young's Reports of Cases. 5.9 

much as the pain was less severe; she had rested better during the 
night, but could not make herself understood any better than before. 
Same treatment was continued, except a blister to the neck. 

9.7th. She is still improving; can connect two words together; 
thus, she replied, when asked how are you to day? «« I'm better." 
How did you rest last night? " much better," she replied. If, how- 
ever, she attempted saying more than this, it was all confusion. The 
lochia has again appeared. Continue same as yesterday. 

28/A. Could perceive a slight mercurial foetor in the breath, and 
it was discontinued. She is gradually improving. Nothing further 
was done, save keeping the bowels free, and in two days more, the 
brain was entirely relieved, and she could converse as well as -before. 
The mouth was not made sore. After she recovered so far as to con- 
verse, she informed us, she comprehended every thing said to her, 
but was entirely unable to recollect her ideas so as to answer; she 
knew that she did not answer aright, " but could not answer any 
better." It appeared to be the faculty of combination that was lost; 
or a congestion of the organ of concentrativeness; a case, differing in 
some respects, from those I have seen published, and furnishing an- 
other very striking example of the possibility of one of our cerebral 
faculties or organs being injured or destroyed, while all the others 
remain undisturbed. 

Case V. Chronic dysentery. — In April, 1827, I was called to pre- 
scribe for Mr. J. E. whose health had been declining for nine or ten 
months, in consequence ef chronic dysentery. He was of a remark- 
ably hale constitution, and had never known what sickness was till at- 
tacked with acute dysentery in autumn 1825. His physician prescrib- 
ed nothing but calomel and opium for him in such quantities, that in 
three or four days he was completely salivated, but he was not cured; 
his bowels remained irritable, with occasional violent attacks of tor- 
mina and tenesmus, with scanty evacuations, frequently of little else 
than mucus; castor oil and laudanum for a length of time relieved 
his attacks, but they continued returning at shorter intervals, until 
he applied to me, when he had all the symptoms of severe dysentery, 
with the exception of the nausea and sickness of stomach, that fre- 
quently or generally attends it, and without any regular fever; he 
had frequently more than a dozen evacuations during twenty-four 
hours, with excessively severe tormina and straining, and never pass- 
ing any thing but slime or mucus, sometimes streaked with blood, at 
other times not unless while under the operation of medicine. He 
was losing flesh rapidly, was pale and dejected; his appetite was not 
particularly affected. I commenced treating him with laxatives, as 



60 Young's Reports of Cases. 

rhubarb in powder, and in its various officinal preparations, with bit- 
ter infusions for drink, and a regulated diet: by these means he was 
apparently benefited, but they were found insufficient to cure. I 
then combined absorbing with relaxing medicines and diet, with the 
same result. Tonics, with blisters to the abdomen, and blue mass as an 
alterative, were persevered in for week after week; turpentine julep, 
bals. copaiva, the most powerful astringents; in short, every mode of 
treatment, and every article that my reading, or reflection could sug- 
gest, were tried, and all without effect. I finally recommended him 
to Dr. Chapman, but he was absent in the country, and he was re- 
commended to Dr. Parrish, with a statement of his case, and treat- 
ment that had been pursued; he suggested a perseverance in the means 
in use, with the addition of a salt-water bath; this was faithfully tried, 
till we were satisfied no good resulted from it. I had told Mr. E. that I 
could not do any thing for him more than I had done, and one of his 
friends recommended him to Dr. Eberle, than a resident in the city. 
Dr. E. prescribed for him several weeks without any benefit result- 
ing. By this time he was emaciated extremely; his weight was re- 
duced from 194 to 122 lbs.; he was sallow, and dejected in spirits; 
his disease was progressing, and he had been under constant medical 
treatment for about fifteen months; his ankles and legs to his knees 
were cedematous, and he was evidently verging rapidly to dissolu- 
tion. He again applied to me, hoping that I might possibly yet think 
of something that might benefit him. I had told him frankly my opi- 
nion of the nature of his disease, that in all probability there were, 
perhaps a number, of ulcers in the intestines, but how to heal them 
I did not know. He stated this to Dr. E. who also told him he be- 
lieved it altogether probable that ulcers did exist. I now commenced 
anew with him. It was now evident, I thought, from his complexion 
and other symptoms, that his liver was implicated materially; an opi- 
nion in which my esteemed friend, Dr. Huston, of your city, con- 
curred, and I resolved on directing a part of my means to this viscus. 
Accordingly, I introduced a seton over the liver, gave him blue mass, 
five grains, every night, with oil next morning; and Dover's powders, 
in ten grain doses, to allay the pain, as occasion may require. For- 
tunately about this time I received the 4th No. of the American 
Journal of the Medical Sciences, containing a paper on chronic dys- 
entery by Dr. J. K. M itchell, in which gum water with blue mass was 
recommended as having speedily cured several cases of that disease. 
In addition to the above means, gum water for diet and drink were 
urged. He commenced with it, and from that day the pain, and the 
discharges from the bowels were found to be so completely controlled 



Young's Reports of Cases, 61 

by it, that the further management of the disease was left to the pa- 
tient's own discretion. He did not confine himself strictly to his 
new diet, as his stomach soon rejected the solution of gum in water; 
he then dissolved it in milk, and used largely of it, but he was so 
rejoiced in having obtained command of his affection, that he pro- 
longed his recovery by indulgences, which frequently obliged him 
to conform strictly to my directions for a few days, when some 
deviation would aggravate his symptoms again. He however per- 
severed for about six or seven weeks, when he found himself 
materially better, and was satisfied that the means in use would 
effect a cure. He discontinued the use of the gum Arabic, and 
with his blue mass, four or five grains two or three times a week, 
and Dover's powder pro re nata, continuing the seton in the side, 
he succeeded in curing himself effectually. The blue mass and 
powders were gradually withdrawn in about three months; the seton 
he wore for some months longer, when it was finally withdrawn, all 
the symptoms of disease having disappeared. He enjoys at this time, 
and has for four or five years past, as good health as he did previous 
to his original attack of dysentery. 

Case VI. Poisoning with laudanum. — October 8th, 1827, I was 
called to Miss — at five o'clock in the morning. Found her coma- 
tose, with deep, slow, stertorous, puffing respiration. Could learn 
nothing about her only that she went to bed as well as usual the even- 
ing previous. It was impossible to arouse her by any means; muscu- 
lar relaxation complete. What should have occasioned such a state 
of things in a hale young girl, was a mystery at the time. There was 
evidently a violent determination to the brain, and I bled her; but I 
had not abstracted more than six ounces before the pulse gave way 
so much as to render it necessary to stop the flow. All that could be 
done was to use sinapisms and frictions, as she could not swallow; 
cold cloths were kept constantly on the head. These were faithfully 
applied, and in twenty minutes, the pulse having filled up, I again 
opened the orifice, and drew about ten ounces more blood, when 
the pulse again failed, and I bound up the arm. I left at 6 
o'clock, after recommending a continuance of the sinapisms, fric- 
tions, and cold to the head. I saw her again at 8 o'clock. But 
very slight alteration had taken place, except now she moaned fre- 
quently, and thus evinced some more sign of returning animation. 
The pulse was again full, though soft and yielding: I bled again: the 
pulse held out till about a pound was extracted, when it again failed. 
I again left, with an injunction to persevere in the former external 
applications. I did not see her till five in the afternoon: on my entering 



62 Fitz Gibbon on the Forces which Circulate the Blood. 

the room she addressed me — " Ah doctor, I never intended to have 
seen this time." I found her in strong labour, and in less than half 
an hour, I delivered her of a fine boy. The history of the case was, 
that she had become pregnant, though she 'had so artfully managed 
to conceal it, that not a person about the house suspected it; in fact, 
her character was entirely beyond suspicion. She now informed us, that 
she had taken an ounce of laudanum in a tea-cupful of whiskey, with 
the determination of destroying herself; but she was thwarted in her 
designs, married the father of her infant, and makes a valuable wife. 
In this case, had I known that laudanum had been taken, I should' 
have proceeded differently in the treatment, but certainly not more 
effectually; the whole ounce of laudanum, (I was shown the ounce 
vial, and she assured us it was full,) remained in the stomach, pro- 
ducing its usual effects on the brain and nerves, and I account for 
the success attending the treatment, by supposing the repeated bleed- 
ings and cold applications, to have kept down the determination to 
the brain so far as to prevent any serious injury there, while the con- 
stant frictions with whiskey and Cayenne, together with the sina- 
pisms, aided in keeping up the circulation in the extremities and sur- 
face, and thus enabled nature to triumph over the effects of the liquid 
poison. By care, and the usual means that would suggest themselves 
to any one accustomed to treating disease, she was completely re- 
lieved from every effect of it in five days. 

Chester ', August 5th, 1833. 



Art. V. On the Forces by which the Blood is Circulated. By 
Maurice Fitz Gibbon, M. D. 

X HE powers which circulate the blood, have" been subjects of in- 
quiry ever since the great discovery of the circulation, and numerous 
are the opinions that have been offered to account for the motion of 
this fluid; and yet it may be fairly asked, what do we really know, 
on which there rests no doubt in addition to these facts, that the 
blood is circulated, and that it acquires motion by the contraction of 
the heart. It is true we do know a little more, but this little has 
oeen, I think, greatly overrated, both in respect to its importance, 
and the degree of certainty which is attached to it. 
Notwithstanding all that has been said on the subject of the dias- 



Fitz Gibbon on the Forces which Circulate the Blood. 63 

tole of the cavities of the heart, it is not yet generally understood, 
whether the fibres of the heart are active or passive while the diastole 
is being effected, i. e. whether the fibres constituting the muscular 
parietes of the auricles and ventricles of the heart, are relaxed in 
each cavity during the time in which they receive blood, or whether 
they are actively concerned in dilating the cavity into which the 
blood enters. The opinion of Harvey is that which almost generally 
prevails in the schools. He contended that a state of inertia or re- 
laxation succeeded to the systole of the heart, and that the heart 
itself is the sole mover of the blood. Thus supposing the auricles 
to be full of blood, and the ventricles empty; the former, according 
to his view, contract, force the blood into the latter cavities, separate 
their relaxed walls from each other, and distend them. The ventri- 
cles now filled with blood, contract; the tricuspid and mitral valves 
are closed by the pressure made on the blood; the semilunar valves 
are opened by the same cause; the blood is forced into the arteries of 
the greater and lesser circulation, it moves onwards through the arte- 
ries into the veins, back again through the latter vessels to the auri- 
cles of the heart with undiminished velocity, and these cavities it 
enters, dilates, &c. The blood from the right ventricle goes through 
the arteries of the lungs, and from these into the pulmonary veins, 
thence into the left auricle. The left auricle forces it into the left 
ventricle, which contracts, forces it into the aorta, thence into all 
parts of the system, from which it is continued in motion by the force 
impressed upon it, into the veins, and by these to the right side of 
the heart. 

Of all the modern writers who adopt the above opinion, there is no 
one who is less equivocal in his belief of it than Dr. Barry. " The 
supposition," he says, " that the cavities of the heart possess the 
power of dilating themselves, and therefore of acting alternately as 
suction and forcing pumps, although adopted by some physiologists, 
has hitherto derived but little support either from anatomy or expe- 
riment. This opinion was too trite, even in the days of Harvey, to 
merit serious refutation. Neither the auricle nor the ventricle ap- 
pears to be furnished with any intelligible muscular apparatus, by 
which either can accomplish its own dilatation." 

Although the opinion of those who contend for the active diastole 
of the heart is not incompatible with the peculiar doctrine of Dr. 
Barry on the " influence of atmospheric pressure upon the progression 
of the blood in the veins," still it seems to be any thing but pleasing 
in his sight, and creditable in his estimation. Were Dr. Barry to 
view the influence of the active diastole in the light I do, he might 



64 Fitz Gibbon on the Forces which Circulate the Blood. 

acknowledge that it is real, and yet not fear for the credit of his own 
views. But Dr. Barry, in denying the diastole to be active, denies, 
in fact, what he appears to aim at, that is, the suction power of the 
heart. It would appear, if we may be permitted for a moment to 
look into Dr. Barry's sentiments respecting his discovery, that he 
strongly apprehended a rival pump in the diastole of the heart, even 
though he assures us, "the supposition that the cavities of the heart 
possess the power of dilating was too trite even in the days of Harvey, 
to merit serious refutation." Now I admit that Dr. Barry's views 
on the influence of respiration are not without proper foundation, but 
in my opinion he has greatly overrated the influence actually exerted 
by that power. Those also who have contended that the heart acts 
as a powerful sucking pump, have also, in my opinion, been equally 
in error with Dr. Barry; while the views of Harvey, though forcibly 
objected to by all who contend for the powerful influence of suction in 
one or the other way, appear liable but to a few objections. An in- 
quiry into the influence of the agents to which I have now alluded, 
will constitute the principal subject of this paper. 

Jlctive diastole of the heart. ^Experiment has proved in the hands 
of many, who have carefully investigated the subject, the active dias- 
tole of both the auricles and ventricles to be real, contrary to what 
Dr. Barry asserts; and we can oppose to his opinion on the subject, 
that of Bichat, Magendie, Richerand, Langrish, Hamberger, 
and several other eminent physiologists. Still more recently we have 
the authority of Dr. Thomas Robinson, of Virginia, a highly talented 
physiologist, who published his remarks on the circulation of the 
blood in the 22d No. of this Journal. 

Richerand, it must not be concealed, has used the following lan- 
guage: — "The cavities of the heart, however, are not entirely pas- 
sive during dilatation;" and this leaves me somewhat at a loss how 
to consider his opinion on this subject, for I do not believe simply in 
a diastole, in the least extent passive, but fully and completely active. 
However, he either believed in the active diastole of the heart, or 
was most inconsistent with the results of his own observations, for 
he also says, " if you attempt to check the diastole of the heart, this 
organ resists the hand which compresses it, and its cavities appear 
endowed with a power which Galen termed jmlsive; in virtue of 
which, they dilate to receive the blood, and not because they receive it. " 

Magendie also observes — "all that has been said of the force of 
the heart, relates only to its contraction, its dilatation having been 
considered as a passive state, a sort of repose of the fibres; however, 
when the ventricles dilate, it is with a very great force, for example, 



Fitz Gibbon on the Forces which Circulate the Blood. 65 

capable of raising a weight of twenty pounds, as I have many times 
observed in animals recently dead. When the heart of a living ani- 
mal is taken hold of by the hand, however small it may be, it is im- 
possible by any effort to prevent the dilatation of the ventricles. The 
dilatation of the heart then cannot be considered as a state of inaction 
or repose. 

Even Bichat, who lays a lower estimate on the influence of the 
heart in circulating the blood, than any other physiologist, says, 
"we shall see that this kind of motion is real to a certain extent, 
both in the heart and the organic vessels. But here it is wholly dif- 
ferent; the heart dilates of itself when it is empty, as we see by draw- 
ing it out of a living animal, and by emptying it afterwards of the 
fluid it contains, because it has in itself the cause of dilatation." 

We do not find in the works of the older physiologists, opinions 
similar to those I have now given, for reasons I shall hereafter notice; 
but that Harvey, Haller, and others felt the heart dilate as forcibly as 
Bichat, Magendie, and Richerand, cannot be doubted; they however 
did not understand it alike with those who have entertained the op- 
posite opinion. 

I might go on to show, that the diastole is active, by many other 
authorities who have observed and described the action of the heart, 
were it really necessary. But I cannot omit referring to the case of 
Dr. Robinson, in a previous No. of this Journal, in which the 
active diastole is so fairly and satisfactorily observed, as to remove 
whatever doubt may still exist on the subject. 

I should be guilty of an unpardonable omission were I at this time 
to leave unnoticed the view of Dr. Hope, of London, " of the phy- 
siology of the heart's action," which he terms new in the very title 
page of his " Treatise on the Diseases of the Heart and Great Ves- 
sels," published in 1832. This view, notwithstanding the great pre- 
caution which the author used to obtain correct results in his expe- 
riments, appears to us to be extremely erroneous, and calculated to 
misguide every person who may confide in the principles which he has 
laid down. W T hile I thus openly express my sentiments as to the 
character of the work of Dr. Hope, I can with pleasure say, that I 
have no where met the action of the heart so faithfully, fully, and, in 
my opinion, correctly described. His experiments are minutely de- 
tailed, and I am satisfied every particular as it appeared is correctly 
recorded; but he did not permit his views to be governed by his ex- 
periments, and the exact observations which he took the trouble to 
make. 

It is scarcely necessary to remark that the rythm, or order of sue- 
No. XXV.— Nov. 1833. 7 



66 Fitz Gibbon on the Forces which Circulate the Blood, 

cession in the action of the heart, is a matter of the highest import- 
ance to be understood, and this of course can only be the case when 
the action of the heart itself is distinctly known. According to the 
observations of Dr. Robinson, the following is the order of succes- 
sion — diastole, systole, repose, and, as he observes, " Bichat's ex- 
periments led him to the same conclusion," and presently I shall 
show, from Dr. Hope's account of his own experiments, that he has 
seen exactly the same thing with Dr. Robinson. The rythm, accord- 
ing to Dr. Hope, is systole, diastole, repose. I conceive the entire 
error of Dr. Hope to arise from the following opinion, with which he 
almost commences his book. Speaking of the diastole of the heart, 
he remarks, " it is perhaps safer for the present to attribute the dias- 
tole to that power by which a muscle reverts from the state of con- 
traction to that of relaxation, and which I shall, for the sake of avoid- 
ing circumlocution, designate by the term elasticity." Now, this 
diastole Dr. Hope terms active, but let it not by any means be un- 
derstood that this diastole is the same as that which I contend for. 
Again, Dr. Hope says, "the systole is followed by a diastole, which 
is an instantaneous motion, accompanied with an influx of blood from 
the auricles." I have now only given what we may consider as mere 
opinions of Dr. H. but in the following we have in his own words 
also an account of an experiment. " I found the auricle to contract 
first, not slowly, but with a motion so rapid as to be almost instanta- 
neous; the moment the fluid reached the ventricle the latter was seen 
to start up evidently by the contraction of its fibres on the fluid which 
it contained, and not by passive dilatation. This more fully proved 
at a later period of the experiment, when the action of the heart was 
from time to time suspended, and the ventricle lay quiescent, though 
partially distended with blood, for then the auricle often made two or 
three contractions which had no stimulant effect on the ventricle, 
while a fourth, not more violent than the preceding, and therefore 
not injecting more blood, caused it to spring up in the manner al- 
ready described." Dr. Hope then unquestionably saw and remarked 
what I consider to be the active diastole. This very " starting up" 
of which he speaks, I regard as an active diastole, and such it must 
be regarded, unless we grossly misinterpret its character; his own 
words, in fact, are so plain on this subject, that they need no com- 
ment to show that he most assuredly saw the heart dilate, but as this 
probably did not agree with his preconceived notions, he did not see 
it to advantage. 

Dr. Hope has seen the ventricle start up by the contraction 
of its fibres, " and not by passive dilatation." Dr. Robinson felt the 



Fitz Gibbon on the Forces which Circulate the Blood. 67 

ventricles suddenly spring dilated with surprising force;" have these 
gentlemen, then, not seen and felt exactly the same thing? i. e. have 
they not observed an active diastole of the heart? Certainly they 
have. 

Dr. Hope has also afforded us another evidence in favour of the 
active diastole of the heart; he says, " the ventricle lay quiescent 
though partially distended with blood, for then the auricle often made 
two or three contractions which had no stimulant effect on the ven- 
tricle; while a fourth, not more violent than the preceding, and there- 
fore not injecting more fluid, caused it to spring up in the manner 
already described." Here, then, we perceive that without the power 
to dilate actively, the auricles could not distend or fully expand the 
ventricle. Mr. Brodie, and many other physiologists have witnessed 
the same want of power in the auricles; but they did not recognise 
that a diastole and not a systole followed the contraction of the auri- 
cles. I have seen the auricles contract and dilate in animals as many 
as seven times for one of the ventricles when the lungs were col- 
lapsed, but when respiration was maintained by artificial means the 
ventricles recovered to a considerable extent their power of acting. 
" The fourth contraction," says Dr. H. " caused the ventricles to 
spring up." "What an illogical conclusion is this! how easily refuted! 
as if, indeed, the power of the auricles were the cause of the dilata- 
tion of the ventricles. 

Dr. Hope supposing that the diastole follows the systole, speaks of 
blood entering the ventricles: — " The systole is followed by a dias- 
tole, which is an instantaneous motion, accompanied with an influx 
of blood from the auricles by which the ventricles reexpand." This 
I know to be incorrect as a general rule; in some animals I have no 
doubt blood may enter the ventricles at the commencement of the 
repose from the auricles, but in my own experiments I have seen the 
ventricle of the frog's heart after contraction, small, pale, and void 
of blood, and suddenly it would "start up" and instantly receive 
blood and expel it again, and suddenly return to the state of repose. 

In contracting, the heart is thrown into a state from which it re- 
bounds, or falls back again, as Dr. Robinson described it, to the 
" stillness of death," and although in the regular or natural frequency 
of action this is but a moment of repose, yet so perfectly at rest are 
the ventricles, that this time of repose, even though it be but for the 
third of a second, is so well marked and evident, that we are always 
struck with it in observing the action of the heart. What is meant 
by the " stillness of death" will be understood when the heart is ob- 
served just when it is removed from an animal after its life has dis- 



68 Fitz Gibbon on the Forces which Circulate the Blood. 

appeared, or in observing a heart in action, it will be perceived that 
the time of repose becomes longer as life declines. When an animal 
is struck on the head, and in this way made insensible, on opening 
its thorax and pericardium we find the heart in a state of rapid and 
violent action: in a short time it becomes slower and more regular in 
its movements, the times of repose become gradually longer, until 
finally the scene closes and all is at rest. The heart however under- 
goes no sudden change in its appearance. The repose in death re- 
sembles the last repose in life, except in its duration. On cutting 
through the ventricles of the heart soon after they have died, we find 
in some cavities of considerable size, in others the walls closely ap- 
proximated. In the latter state I have found the hearts of birds, frogs, 
and some other animals; while in others again, the cavities were 
much larger, but capable of becoming much more capacious. 

As the heart then, in many cases, presents the ventricles by no 
means dilated in the state of repose, and consequently containing 
but little or no blood in that state, it is evident, I think, that all who 
have described the diastole of the ventricles as preceding the state of 
repose, and succeeding the systole, have greatly erred. The ventri- 
cles unquestionably return to the state of repose with some force, and 
all the appearance of being contracted in that state is absent; the 
ventricles really appear at rest, and the form which they have then 
is not different from what they present soon after death: this is in 
my opinion a state of relaxation as complete as that which any other 
muscle of the body enjoys, but the appearance here is somewhat dif- 
ferent, for the ventricles feel firm and rather unyielding. The ven- 
tricles then, in the state of repose, I do not believe to be under the 
influence of any power tending to dilate or contract them, and here 
I must differ from Dr. Robinson, who says " the antagonizing powers 
were merely in equilibrio," or that " probably the contracting power 
predominated." This opinion, it will be seen, quadrates perfectly 
and without any forced effort, with the result of my experiments on 
the structure of the heart. 

The active diastole of the auricles, though less striking than the 
diastole of the ventricles, is notwithstanding not less real. It is how- 
ever not powerful like that of the ventricles, but it happens equally 
quick with it. The active diastole of the auricles did not escape the 
notice of Magendie, who remarks, « I have said that the blood of the 
three veins that are in the right auricle makes a considerable effort 
to penetrate into it. Jf it is contracted this effort has no effect, but as 
soon as it dilates the blood enters its cavity, fills it completely, and 
even distends the sides a little; it would immediately enter the ven- 



Fitz Gibbon on the Forces which Circulate the Blood. 69 

tricle if it did not contract itself at this instant. The blood, then, 
confines itself to filling up exactly the cavity of the auricle; but this 
very soon contracts, compresses the blood, which escapes into the 
place where there is least compression; now, it has only two issues — ■ 
1st, by the vena cava; 2d, by the opening which conducts into the 
ventricle. The columns of blood which are coming to the auricle 
present a certain resistance to its passage into the cavae or coro- 
nary veins. On the contrary, it finds every facility to enter the ven- 
tricle, since the latter dilates itself with force, tends to produce a 
vacuum, and consequently draws on the blood instead of repulsing 
it. " The same is true for the opposite side of the heart. I have here 
quoted at length the opinion of Magendie, not only in relation to the 
diastole of the auricles, but on other points of much importance, be- 
cause I am convinced, by repeated observations on the action of the 
heart, of their correctness. 

In the 12th Vol. of the Philadelphia Journal of the Medical and 
Physical Sciences, (for 1826,) Dr. Hays published his views on the 
forces by which the blood is circulated. On this subject he observes, 
that "in vain some physiologists have contended that the heart is di- 
lated, and does not dilate itself, and that this dilatation is absolutely 
passive; the dilatation of the heart is a true effort, an active move- 
ment," &c. 

Dr. Robinson says, " the diastole appeared to commence in the 
venous sinus, and pass without interruption and with immense velo- 
city to the apex; the systole pursued the same course with equal ve- 
locity." There is then no alternation according to this gentleman in 
the action of the auricles and ventricles; they are in a state of repose 
at the same time, they dilate at the same time, they contract at the 
same time only with this difference, that action always commences in 
the auricles and extends into the ventricles without interruption." 

The description of the action of the heart given by Magendie ap- 
pears to me to be more in accordance with facts than that of Dr. Ro- 
binson. Dr. Hope's opinion on this subject is less exceptionable than 
Dr. R.'s. He has not represented phenomena as they appeared to 
him, out of their natural order, but he failed exceedingly, as I think 
I have already shown, in not recognising them in their true charac- 
ter: he admits that the systole of the auricle is followed by the dila- 
tation of the ventricle; but he erroneously considered the diastole 
thus produced as the consequence of the preceding auricular systole, 
and not what resulted from the "true effort," "the active move- 
ment" of the ventricle itself. He also mistook the repose of the ven- 
tricles for a state of distention; which indeed could not be called with 

7* 



70 Fitz Gibbon on the Forces which Circulate the Blood. 

propriety a state of repose; and the collapse of the heart after the sys- 
tole, he mistook for an active diastole, and by this last error he was 
led into false principles. Dr. R. however, has not expressed his opi- 
nions without doubt, and if there be any room to object to his having 
ventured to institute principles, I think it must be, that he never ex- 
tended his observations beyond the case which he has published. Leav- 
ing the views then of these gentlemen for the further examination of 
those who may be particularly interested in the improvement of aus- 
cultation, I now return to the subject with which I am at present 
more particularly interested, but here again I find myself opposed to 
the opinions of Dr. R. in a new point of view. 

" While Bichat," says Dr. Robinson, " affirms that the heart di- 
lates with a force which no effort of the hand could prevent, is it not 
surprising that he has neglected to supply a power so great and so 
obvious to the elucidation of that obscurity of the venous circulation, 
on which, he acknowledges, authors have hitherto shed few rays of 
light; to you it is unnecessary to demonstrate that the pressure of the 
atmosphere on the veins external to the cavities must be propagated 
to the termination; that the cavities being always full, there is a con- 
tinued pressure on the vessels within them; add to this the powerful 
dilatation of the heart, auricles and ventricles cooperating in the ac- 
tion, as I have seen them, and you have all the requisites of a pow- 
erful sucking-pump, operating perpetually on the venous system." 

Dr. Robinson's surprise that Bichat did not apply the active dias- 
tole of the heart to the " elucidation of the obscurity," &c. is easily 
accounted for. Bichat viewed the diastole of the heart in a manner 
very different indeed from Dr. R. Bichat did not believe that the 
auricles and ventricles cooperated in the dilatation of the heart; how 
then could he, indeed, look on the heart as a "powerful sucking-pump, 
operating perpetually on the venous system;" for to act as such, I 
contend the auricles and ventricles should dilate simultaneously; now 
this I also contend they never do. 

I may still further notice the argument of Dr. Robinson in favour 
of his opinions, "founded on the structure of the heart itself." 
"Whoever," he argues, "inspects with candour and attention the 
structure of the valves, will find it difficult to persuade himself that 
they are adequate to the function generally assigned them; he mav 
easily ascertain that they offer an impediment to the reflux of the 
blood, but hardly that they afford a complete obstruction; but as the 
contraction of the auricles is less powerful than that of the ventri- 
cles, such reinforcement seems necessary to prevent reflux." 

I have, nevertheless, examined the hearts of many animals with 



Fitz Gibbon on the Forces which Circulate the Blood. 71 

" candour and attention," and still I cannot persuade myself that 
they are not adequate to the function which the illustrious Harvey 
first assigned them, and which I am satisfied they will be regarded 
as executing by all who examine them. 

The contraction of the auricles always aids in filling the dilating 
ventricles, and is, I think, the principal cause. I admit, of course, 
that atmospheric pressure would cause a fluid to rush through an 
opening into an exhausted vessel; but I cannot, on this account, see 
any good reason why indeed atmospheric pressure, and not the auri- 
cular contraction, should cause blood to pass from the auricles while 
contracting into the ventricles while dilating. The systole of the au- 
ricles is prompt and sufficiently powerful to throw blood into the ven- 
tricles; it commences an instant before the diastole of the ventricles, 
it is in full force when the latter commences; and when the systole 
of the ventricles is in operation, the auriculo-ventricular valves are 
closed, and the diastole of the auricles commences. 

That atmospheric pressure is calculated also to cause blood to en- 
ter the auricles when they are dilating, is what cannot be denied; it 
certainly does not oppose the movement of the blood into the auri- 
cles, but if from other causes the blood move with sufficient velocity, 
as I think it does, why assign an effect entirely to atmospheric pres- 
sure which it only produces in part. 

Structure of the heart. — Believing that the structure of the heart 
must be understood before its action can be explained, I undertook 
to examine it at a time when I was not aware of the exact state of 
knowledge on the subject. After several experiments, I found that the 
sheep's heart, boiled slowly in a solution of pearl-ash, answered my 
purposes very well. As there is still further room for investigation 
on the subject, I shall give a brief account of the manner in which I 
attempted to unfold the heart. 

On raising a few fibres on the external surface of the heart, I found 
it easy to detach them from the substance of the ventricles, tracing 
them from the base towards the apex. I commenced on the surface 
of the right ventricle, the fibres are all spiral, running from right to 
left over the anterior surface, and back again from left to right on 
the posterior surface, until finally, after two or more turns, they cease 
at the apex; these are the external fibres, which on being raised let 
into view those which are below them, and these, gradually, as we 
descend into them, are found to lie more transverse, but still spiral. 
Nothing like a laminated or fasciculated structure is observable, and 
the fibres lie very close to each other. The most superficial fibres 
extend to the apex, the most prominent part of which they constitute; 



72 Fitz Gibbon on the Forces which Circulate the Blood. 

those which are next beneath, extend also to the apex, into the com- 
position of which they enter, and so on with others. The external 
fibres, at the very summit of the apex, are continued into the left 
ventricle, and there form the surface immediately under the lining 
membrane; those which I have spoken of as lying beneath the most 
superficial and external, hold the same relative position to the super- 
ficial internal, so that a certain portion of the fibres may be found 
composing the external and internal surfaces of the left ventricle, and 
these fibres, common to both surfaces, are the same and continued. 

Continuing further to unfold the ventricles, it is found that the 
fibres fall short of the apex by degrees as we descend into the struc- 
ture, until finally we find many of them confined to the composition 
of the base. 

In the course of the unravelling, for such it may be fairly called, 
the anterior wall, which is composed of fibres to a great extent com- 
mon to both ventricles, is removed. The right ventricle, however, 
is not composed entirely in this way; there are fibres on its internal 
surface which are common to it and the septum. 

Having arrived at the substance of the left ventricle which is pe- 
culiarly its own, that is, after all the fibres which are common to the 
external part of both ventricles are removed but not broken, it is 
very easy to finish the unfolding, when it will be perceived that all 
the fibres intermediate to those which were first mentioned, after 
winding around twice or more then take a direction upwards, they 
enter into the composition of the columnse carneae. 

We may consider most of the fibres as originating at the base of 
the heart wherever there is cartilaginous matter; but many of the 
fibres arise from the inner surface of the ventricles, and running out 
at the auriculo-ventricular opening become superficial and external 
after having given rounded margins to the cavities from which they 
passed; on the surface they run the course which was first described. 

The termination of the fibres may also, in a great degree, be traced 
to small tendons, or cartilage looking into the cavities, or placed at 
the summit of the septum, where also the auricles are attached. 

As the superficial fibres often wind around the ventricles two or 
three times before their spiral course terminates in that which is 
straight in the columnse carneae; so indeed do all the fibres beneath 
them. Suppose a fasciculus of these fibres to extend the course I 
have pointed out, then it must be seen that it may be represented by 
a coil of wire, the inner part of which is continued in a straight di- 
rection, and at right angles with the coil; by depressing the extre- 
mity of this wire, which represents the continuation of the fasciculus 



Fitz Gibbon on the Forces which Circulate the Blood. 73 

in the columnse carnese, the coil will be converted into a conical 
spire, perpendicular to which the straight part of the wire still re- 
mains. Suppose another coil, smaller in diameter and similarly form- 
ed, be introduced within the first coil, and its straight wire be de- 
pressed somewhat less than the first, this will represent the next or- 
der of distribution, and so on. Attending to what was said in the 
general description, and retaining this mode of illustration in mind, 
it may be perceived that the ventricles are composed of muscular 
coils, disposed in spiral and somewhat conical form, that the spires 
become shorter as they are less superficial. But as they become less 
superficial, it must be remembered that the inner straight continued 
part of the coils become less perpendicular, and finally, in the most 
deep-seated, it forms a very acute angle instead of the perpendicular 
before described. 

I have not yet obtained results in my experiments on the auricles 
so satisfactory as to induce me to attempt a description of them. 
This however is evident to me, that the fibres of the auricles and 
ventricles are perfectly distinct from one another. In one case out 
of seventeen I found a strong fasciculus of the fibres of the right au- 
ricle perfectly identified with the structure of the ventricles: the con- 
nexion between them was made by a distinct column about three- 
quarters of an inch long. 

We often perceive muscular columns or bands extending from one 
side of a ventricle to the other; I have observed that their direction 
is always oblique, and not directly transverse from one side of the 
cavity to the other, under which circumstance they would greatly 
embarrass the diastole of the heart. These bands do not make it 
more difficult to examine the structure of the heart, as might be at 
first sight supposed. Even the net-work, which the ventricles some- 
times present on their inner surface, will yield satisfactorily if the 
heart be properly prepared. 

I am not prepared to offer an opinion as to the manner in which 
the diastole of the heart is produced. I would therefore merely ask, 
is it the consequence of muscular contraction? The only way in 
which I can perceive that the diastole of the ventricles may arise 
from muscular contraction, is that all the fibres of the heart are sti- 
mulated to contract at the same time, but we know that the internal 
surface of the heart is more irritable than the external, and this can 
be proved satisfactorily. It is the muscular fibres of the internal sur- 
face, then, that are more irritable than the external surface; but it 
has been shown that there is no interruption or separation of conti- 



74 Fitz Gibbon on the Forces which Circulate the Blood. 

nuity between the external and the internal muscular fibres. It ap- 
pears from this that one part of a muscular fibre may be more irrita- 
ble than another part. Now, if this be true, it may also be true, that 
one part of a muscular fibre can contract quicker than another part. 
Let us then suppose that the columnse carnese, which constitute but 
a small portion of the entire length of the fibres of the heart, is more 
irritable, and contracts more readily than the spiral part, would the 
ventricles on this account be thrown open suddenly, and closed a lit- 
tle more slowly, by the more gradual and superior power of the spiral 
fibres? 

I have been to a considerable extent anticipated in my views of 
the structure of the heart by Lower, who published his account of 
it in 1708. 

Influence of respiration and of the active resiliency of the lungs in 
drawing blood into the thorax. — The experiments of Dr. Barry leave 
but little doubt I think, that inspiration, under some circumstances, 
tends to draw blood into the thorax; but I am induced to believe that 
he has greatly overrated the results. My object at present is not to 
analyze Dr. B's views, but to attempt to show in a few words, how 
far we are to regard atmospheric pressure and the expansion of the 
thorax, as calculated to influence the motion of the blood in the veins. 

Speaking of the powers which circulate the blood in the veins. Dr. 
B. asserts, " of these powers the pressure of the atmosphere is by far 
the most intense in its degree, the most constant in its influence, and 
the most unvarying in its amount. It is that without which the cir- 
culation could not be maintained beyond a few moments." We shall 
presently see how Dr. Barry has attempted to verify this assertion, 
with but little success, and how the slightest evidences in its favour 
have been regarded by him as conclusive, while the want of them 
never, for a moment, elicited from him an expression of doubt as to 
the correctness of his doctrine, in the full extent to which he has 
urged it. 

As it at once opens to view the ground-work of Dr. Barry's theory, 
I quote the following part of his " argument drawn from anatomy." 
" When the chest is enlarged by the act of inspiration, air rushes in 
through the trachea, to distend the air-cells, and force them to oc- 
cupy that space in which the expanding parietes of the thorax tend to 
leave a vacuum. But as it is evident, that the air would follow the ex- 
panding sides of the chest much more readily if there were no cells 
to be distended, and as it is an unalterable law that all liquids in 
communication with an enlarging cavity, will be pressed towards it 



Fitz Gibbon on the Forces which Circulate the Blood. 75 

if exposed at the same time to atmospheric influence, it became pre- 
sumable that blood would be forced into the thorax through the cavae 
during inspiration." 

I make no objection to this argument; it is well known to every 
anatomist how powerfully elastic the substance of the lungs is, con- 
sequently the tendency which it constantly has to collapse, and to 
oppose a distending agent. When the thorax is expanding in inspi- 
ration, it is certainly tending to the production of a vacuum within, 
and the air rushing in through the trachea and its various ramifica- 
tions to fill the vacuum as fast as it is formed, meets a resistance in 
the collapsing power of the lungs; now, as the power of resistance in 
the lungs is something opposed to the expanding power of the thorax 
on the one side, and to the pressure of the atmosphere on the other, 
we at once perceive strong reason to suspect, that all the veins com- 
municating with the cavity of the thorax, and exposed to the influence 
of atmospheric pressure from without, are liable to have the blood 
which they contain pressed into the great venous trunks and the au- 
ricles of the heart when they dilate. 

Dr. Barry's experiments to prove the production of a tendency to 
a vacuum in the chest during inspiration, I must make known in 
fewer words than he uses. 1st Experiment. A horse was thrown 
upon his right side, left jugular vein exposed, tied below its middle, 
opened an inch below the ligature, a large flexible catheter introduced 
into the open vein and directed towards the heart. To the other ex- 
tremity of the catheter a spiral glass tube was connected, the extre- 
mity introduced into a vessel containing coloured fluid which ascend- 
ed through the tube into the vein, and probably into the heart, during 
inspiration. Blood regurgitated into the tube when the respiration 
was hurried, but returned into the vein at the next inspiration. This 
I call a mere imitation of what we observe in the jugular veins of 
mammalia, and sometimes in the jugular veins of persons in coughing, 
laughing, &c. where the blood is forced into the veins of the neck, 
and drawn back again when inspiration is made. In the report made 
to the "Royal Academy of Sciences, Paris," upon " Dr. Barry's 
Memoir," by Baron Cuvier and Dumeril, the observations of 
Rudiger, Santorini, Haller, Valsalva, Morgagni and M. Ma- 
gendie, on the progression of the blood through the great veins to- 
wards the heart during inspiration are alluded to, not one of whom 
it appears accounts for this phenomenon correctly. To Dr. Barry 
then belongs the credit of having pointed out the mechanism by which 
it is effected, which will be further seen by a short notice of his se- 
cond experiment. 2d Experiment. Two tubes ingeniously contrived 



76 Fitz Gibbon on the Forces which Circulate the Blood, 

introduced into the cavity of the thorax, one on each side of the pos- 
terior extremity of the sternum, the animal being on its back. The 
other extremities were immersed in coloured liquid. The tubes pe- 
netrating into the cavities of the pleurge made a communication be- 
tween them and the external fluid. The fluid rose rapidly in the 
tubes during inspiration, and was drawn into the chest. I may also 
now give a brief account of Dr. B's 3d experiment. This was made 
with a view to ascertain whether a tendency to a vacuum was also 
produced in the bag of the pericardium. Having succeeded in intro- 
ducing a tube into this bag, he proved that a fluid ascended through 
it during inspiration. These experiments leave no doubt as to the 
production of a tendency to a vacuum in the cavities now alluded to; 
but while this is admitted as true, it must be acknowledged that the 
power which they exert in drawing to them blood from the veins is a 
subject which still requires to be investigated. Dr. Barry lays an 
estimate on it which no person conversant with anatomy and the phy- 
sical sciences will receive as correct, and while the Baron Cuvier 
and professor Dumeril in reporting on his memoir, speak in the highest 
terms of his experiments, they evidently have not included the 
opinions of Dr. Barry in their commendation. 

In noticing the active resiliency of the lungs, let it not be supposed 
that I am giving my support to Dr. Carson's doctrine. I believe in 
the active resilience of the lungs, and so does every person who is at 
all conversant with anatomy, but I give but little credit to the fine- 
spun doctrine of Dr. Carson. 

As the lungs are highly elastic and in a forced state of distention 
while they remain sound during the life of an animal, so they have 
a constant tendency to collapse, but in order to do so, they should 
leave a vacuum in the cavities of the pleurae, and also I think in the bag 
of the pericardium. It is very evident they have not the power to 
do so, and they must be regarded therefore at least in the quiescent 
state of the thorax, as leaving no empty space between them and the 
walls of the thorax. The collapsing power of the lungs is considerable, 
but no proper estimate has been made of it; we know how forcibly it 
draws up the diaphragm; it draws, we have reason to believe with 
equal power on the hard thoracic walls all around. Now as there are 
two great cavities separated from one another by the mediastinum, 
it is perfectly in accordance with experience to suppose, that the col- 
lapsing power of the lungs acts with as much power on the medias- 
tinum as on any other surface with which the lungs are in contact. 
But the heart and pericardium are to a great extent concerned in 
opposing the collapsing power of the lungs; the pericardium is also a 



Fitz Gibbon on the Forces which Circulate the Blood. 11 

sack, and its capacity is not filled by the heart, Dr. Carson therefore 
supposes that the collapsing power of the lungs keeps the pericardium 
in a constant state of extension, and that an antagonizing power to 
the muscular fibres of the heart is thus produced, which operates con- 
stantly to dilate the heart; I certainly cannot agree with the learned 
author of this doctrine, and think he has betrayed great deficiency 
of knowledge in pneumatics in forming it. Had he been better ac- 
quainted with this branch of philosophy, his doctrine would doubt- 
less never have appeared in print. But, let us see in what more 
particularly his error consists. The collapsing power of the lungs is, 
as I have already said, considerable. Dr. Carson made experiments 
to ascertain its amount, and found that it was equal to a column of 
water seven inches high, its ratio then to atmospheric pressure is 
nearly as 1 to 56; its tendency to produce a vacuum is also in the 
same ratio, it cannot therefore with so great a power against it, form 
a vacuum. 

I have not made experiments expressly with a view to measure 
the collapsing power of the lungs in any class of animals, but from 
general observation on the subject, I think the following opinions 
correct. The collapsing power of the lungs increases in an unknown 
ratio as the lungs are inflated from the state of entire collapse, to the 
size which they ordinarily occupy in any animal; beyond this their 
power of resisting a distending power increases in a far greater ratio 
than that before alluded to. The air rushing into the lungs while 
the thorax is expanding, distends the lungs and makes them keep 
pace with the expanding thorax, but when the air does not pass 
through the rima glottidis in volume commensurate w T ith the increase 
of capacity produced in the thorax, then several things are liable to 
happen; there must be left a vacuum in the cavity of the pleuras, or 
the diaphragm must be caused to move upwards to supply the defi- 
ciency of air; or blood in the veins, external to the thorax, must move 
in, or the air in the lungs must expand by its elasticity and dilate 
the lungs. If a very sudden and powerful effort be made to draw in 
air, it is probable, I think, that all of the preceding effects, except 
the first, would follow at the same time, but no one or two would 
subside before the others, they would all be terminated when any 
one of them restored the equilibrium of atmospheric pressure. 
Further, the effect which required the least power to produce it, 
would precede all the others in its extent. Here we want certain 
data, but we may form an opinion as to the forces concerned. Sup- 
pose the resilience of the lungs in such a case to be fifty; expansive 

No. XXV.— Nov. 1833. 8 



78 Fitz Gibbon on the Forces which Circulate the Blood. 

power of the air three hundred; the latter then would prevail, and 
prevent the production of a vacuum from the very commencement. 
The air thus rarified would however only resist external pressure, let 
us suppose as three hundred to three hundred and ninety. The dia- 
phragm would, therefore, be pressed up into the thorax in an arched 
form, the blood would likewise be obliged to rush in, and collect in 
the cavse, so that we should have all these effects produced at once, 
but not a vacuum. Now, suppose a slow inspiration be made, the 
effects, I think, shall be somewhat different from the preceding; the 
entrance of the air into the lungs shall expand them as freely and as 
quickly as the thorax would expand; the diaphragm instead of being 
pressed up, would be forced down, an evidence that the lungs under 
the last condition nil the cavities tightly from the commencement to 
the end of ordinary inspiration. I see no reason then for supposing 
that during ordinary inspiration, blood is moved into the thorax by 
atmospheric pressure. Nor has Dr. Barry ever proved that it does. 
Head his own words. " The connexion between the motions of the 
liquid in the tube and respiration cannot be satisfactorily observed 
while the horse is standing, because his breathing when in the erect 
posture, and at rest, is scarcely, if at all, perceptible." The circu- 
lation, however, we must presume, is going on rapidly in every part 
of the body, and according to Dr. Barry, even when a gum elastic 
catheter is introduced through one of the jugular veins, and passed 
almost as far as the superior cava, and through which no water will 
ascend, still Dr. Barry asserts, that atmospheric pressure is more 
powerful than any, or all the other forces in moving the blood through 
the veins. 

" Here it is essential to remark, that if the communicating tube be 
introduced into the femoral vein of a dog or horse, and pushed no 
further towards the heart, inspiration will produce no effect upon the 
Jiquid in the cup, because the relative vacuum of the thorax can be 
filled up from the other veins of the animal's body." I will merely 
quote another passage from the report of the Baron Cuvier and Du- 
meril on his memoir. 

"Your commissioners, however, must not conceal that in their 
particular opinion the act of inspiration which appears to produce a 
vacuum within the thoracic cavities of animals having lungs, is not 
sufficient to explain the motion of the blood in the veins of fishes, and 
of some reptiles in which the mode of respiration is different." 

Let any vein, or number of veins be tied as near the heart as is 
possible, it will be found that on puncturing them, a stream of blood 



Warren's Case of Non-existence of Vagina. 79 

will issue and continue to flow perhaps as long as there is life in the 
animal; or if they be not punctured, it will be found that they become 
full and greatly distended below the ligature, showing conclusively 
that atmospheric pressure is not the great cause of the return of the 
blood from all parts of the system. Even Dr. Carson admitted the 
strength of this objection against the extent to which he felt disposed 
to urge his doctrine. To produce additional proof on this point I 
deem unnecessary. It may be found in Harvey's valuable work, 
" De Motu Sanguinis;" Haller's Physiology; M. Magendie's Phy- 
siology; Bichat's Anatomie Generate, and indeed in almost every 
modern work. I can also refer with great pleasure to Arnott's Ele- 
ments of Physics, second American edition. 

I am now constrained to conclude this paper, in which my sole 
object has been to show the necessity of further investigations re- 
specting the forces by which the blood is moved, and to expose the 
errors of those, as they have appeared to me, who, in their zeal for 
the advancement of medical science, have put forth doctrine upon 
doctrine, hypothesis upon hypothesis, error upon error. 

Philadelphia, April 3d, 1833. 



Art. VI . Non-existence of Vagina, Remedied by an Operation. By 
John C. Warren, M. D. Professor of Anatomy and Surgery in 
Harvard University, Boston. 

A YOUNG WOMAN, of twenty-three years old, well constituted, 
applied to me for a natural malformation of the organs of generation. 
On examining, I found the os externum wanting, and so far as could 
be judged, there was no vagina. The aperture of the urethra was 
well formed; the clitoris and nymphae appeared as usual. The breasts 
and all the other external parts were natural; but no uterus could be 
discovered on a careful examination by the rectum, either by Dr. 
Channing, Dr. Hayward, or myself. The patient had never expe- 
rienced any unusual enlargement of the abdomen. 

Believing it possible that the uterus might exist, although not suffi- 
ciently developed to be discoverable by the rectum, I determined to 
comply with the patient's wish, and attempt the formation of an ar- 
tificial passage: for this purpose she entered the Massachusetts Ge- 
neral Hospital in January last. 



80 Zabriskie on Ataxic and Intermittent Fevers. 

The patient being placed on her back on the edge of a bed, feet 
each in a chair, I attempted to pass a probe in behind the urethra, 
but found this impracticable, there being no aperture or excavation. 
The forefinger of the left hand was introduced into the rectum, and 
a small probe-pointed bistoury employed to make an aperture in front 
of the rectum as near as might be in the situation of the fossa navicu- 
laris. This was accomplished, but I was disappointed in finding no 
cavity behind or within this aperture. It was necessary, therefore, to 
proceed with the same instrument, the convexity being towards the 
rectum, to dissect from behind forwards. In this way an opening was 
made sufficient to admit the point of the finger. The dissection being 
carefully continued in the same manner, a passage was formed about 
three inches long, and wide enough to admit the finger. 

The bleeding was considerable; this was arrested by the introduc- 
tion of a tent. Subsequently to the operation she had much fever, 
pain and tension of the abdomen, and suppression of urine. These 
symptoms gradually disappeared. 

The wound was carefully dressed by the introduction of a tent 
daily. The suppuration was considerable; after it had subsided the 
tent was removed, and the passage exhibited no disposition to close. 

On examining subsequently to the cicatrization of the wound, 
something like labia of the os uteri were discovered. 

After her recovery she had some appearance like the catamenial 
discharge. She then left the hospital. Four weeks afterwards she 
was seen by Dr. Hay ward; he found the aperture and cavity open, 
and she had had a sanguineous discharge resembling the catamenia* 
and he thought he could distinguish something like an uterus. 

Boston, July, 1833. 



Art. VII. Some remarks upon Ataxic and Intermittent Fevers. By 
John B. Zabriskie, M. D. Physician to the King's Co. Alms- 
house, New York. 

JjY ataxic or congestive fever is generally understood a fever in 
which cerebral and nervous symptoms predominate. It is attended 
with coma, a low delirium, or stupor, spasms and twitching of the 
muscles. Broussais defines ataxic fever to be a gastro-enteritis 
with considerable irritation or phlegmasia of the brain. Boisseau 
describes it as follows: — " Ataxic fever is an encephalitis, some- 



Zabriskie on Ataxic and Intermittent Fevers. 81 

times primitive, more frequently secondary, generally accompa- 
nied with gastro-enteritis, or supervening in the course of inflamma- 
tion of the lungs, uterus, peritoneum, &c." The difference between 
the views of these celebrated physicians is that one believes the pri- 
mitive cause of this fever to be seated in the brain, while the other 
considers it to be seated in the stomach and intestines. Boisseau, 
while contending for its cerebral origin, says that it is generally ac- 
companied with gastro-enteritis, and Broussais allows the constant 
existence of irritation or phlegmasia of the brain. Post mortem exa- 
mination shows us lesions both in the stomach and the brain: hence 
the great question which arises is, which is the primary irritation? 
nor is this question idle while we allow our views of the seat of a 
disease to have any influence upon our practice. 

Ataxic fever prevailed epidemically in the King's County Alms- 
house in the spring of 1833, commencing in April and continuing un- 
til the end of June. The fever generally assumed a remittent type, 
in some cases it was intermittent, in others the remissions were 
slight, thus assuming the character of continued fever. In every case 
the gastric symptoms were very manifest, and generally were the 
first which appeared. The disease commonly commenced with nausea, 
loss of appetite, uneasy feeling at the stomach, and general languor. 
To these would succeed pain in the extremities, head or back, often 
severe colic pains in the bowels. This state continued in some cases 
for two or three days, in others a shorter period. A chill would suc- 
ceed, which was followed by fever. Pains and heaviness were felt in 
the head with a great disposition to sleep, the conjunctivae became 
red, the face flushed. The pulse at first was quicker and sometimes 
fuller than natural, but soon became weak and slow, the tongue was 
white, often with a red tip, generally moist. The epigastrium was 
tender to the touch, and the nausea increased especially upon taking 
much drink. These symptoms were increased in the afternoon, and 
had a morning remission or intermission. If the fever continued the 
symptoms went on increasing, stupor or a low muttering delirium 
ensued, in some cases amounting to a complete coma. In one case 
deglutition was suspended, and spasms of the muscles existed resem- 
bling tetanus; partial spasms and subsultus tendinum were frequent. 
The faeces and urine were often discharged involuntarily. The epi- 
gastrium in many cases was very tender, so much so that the patient 
could scarcely bear to have it touched. The heat of the trunk and 
head was increased, while the extremities were often cooler than na- 
tural. 

Some cases of pneumonia existing at the time put on the character 



82 Zabriskie on Ataxic and Intermittent Fevers. 

of ataxic fever, and others were accompanied with synocha. But in 
all those cases where ataxic fever accompanied pneumonia, symp- 
toms of gastric irritation appeared first. In one case the fever was 
evidently changed into ataxic by the operation of a powerful purga- 
tive. There were cases of intermittent fever also at the same time 
without symptoms of irritation of the brain. 

No particular cause could be assigned for this fever. The diet of 
the house remained the same, and as much attention was paid to 
cleanliness as at any other period. It was confined to this establish- 
ment, and did not appear in the surrounding country. It evidently 
was not contagious, as those who took care of the sick, who slept in 
the same rooms with them, and had every communication with them, 
did not appear to be more liable to it than others. It is proper however 
to state, that although the fever did not appear in the surrounding 
country, still many persons were affected with this somnolence, some 
complained of falling asleep at their meals or at their ordinary work, 
and their greatest exertions were insufficient to resist it. This was 
always promptly relieved by bleeding in every case which came un- 
der my observation. 

Although pathological anatomy has not advanced to sufficient per- 
fection to show us upon what particular lesion each variety of fever 
depends, still there can be little doubt but that the difference in the 
character of fevers depends either upon the organ affected, the tissue 
of that organ, or the intensity of the irritation. Bilious fever is now 
known to be a gastritis, that form of typhus to which the name of 
dothinenteritis has been given is an inflammation of the glands of 
Peyer and Brunner, dysentery has its seat in the colon, and it is pro- 
bable that when the science of pathology is more advanced, every 
fever will have its seat ascertained. We see that inflammatory fever 
puts on different characters according as it has its seat in different 
organs. Thus rheumatic fever has a full, bounding pulse, the heat of 
the whole body is much increased, the sweating is often profuse and 
has a peculiar odour. Gastritis has a small, chorded pulse, there is 
often great prostration of strength, the heat of the trunk is increased, 
but the extremities are often not much warmer. Pneumonia has a 
fever different from either. 

In diseases which have their origin in the stomach and intestines, 
and where there can be no doubt concerning their seat, we see as 
great disturbance of the functions of the brain and nervous system as 
in this fever. The sympathy and nervous connexion between the sto- 
mach and cerebral organs are so great that the former cannot be se- 
riously affected without influence upon the latter. We see in cholera 



Zabriskie on Ataxic and Intermittent Fevers. 83 

how much the nervous system sympathizes with an intense gastric 
irritation, producing stupor, pain in the head, deafness, redness of 
the eyes, cramps and spasms of the muscles. We see the violent 
head-aches, the melancholy, and mental anxiety consequent upon 
dyspepsia. In bilious fevers and gastritis we often find delirium, 
coma, head-ache, vertigo, and dimness of vision. We also see the 
same effect produced by poisons taken into the stomach which must 
act upon this organ. Although my observations are much too limited 
to pronounce definitely upon the seat of ataxic fever, and especially 
as celebrated physicians have asserted that cases have occurred where 
the gastric symptoms were very slight, and where no traces of lesion 
in the stomach existed after death, yet in all those cases which came 
under my care I do not hesitate to say that the disease had its seat 
in the stomach, and for the following reasons: — 1st. The disease in 
every case commenced with symptoms of gastric derangement, as 
nausea, anorexia, pain, or tenderness of the stomach. 2d. The gas- 
tric symptoms continued very conspicuous throughout. 3d. What- 
ever irritated the stomach increased the fever, as emetics, purgatives, 
and other irritating medicines. 4th. Those remedies which reduce 
gastric irritation were found to be the most successful means of treat- 
ing the fever, as local bleeding from the epigastrium, absolute diet, 
and diluent drinks. 

In treating this disease most medicines appeared to aggravate the 
symptoms, and especially emetics and drastic purgatives. Many 
were cured by mucilaginous and acid drinks alone. Cups or leeches 
applied over the region of the stomach in some cases gave almost im- 
mediate relief, and removed the stupor and pain in the head much 
more quickly than when placed upon the temples. 

I subjoin a few cases illustrative of the fever as it appeared in the 
Alms-house. 

Case I. Daniel Leake, aged thirty-eight, a lunatic, of a plethoric 
habit, was seized on the 12th of April with pain in his back, legs, 
and arms, resembling rheumatism. He complained of anorexia, nau- 
sea, and heaviness of his head, his tongue was slightly furred, and 
his pulse had a little quickness. He took a dose of Lee's pills. 

\Ath. Much worse, very delirious, his eyes are red, face flushed, 
he lies in a continual stupid sleep except when roused, his pulse is 
slow, hands colder than in a natural state, his head and trunk 
warmer. He refuses all food, and has not much thirst. Considering 
his disease as a congestion of the brain, calomel was given internally 
followed by senna and salts, cups were applied to the temples, and 
sinapisms to the feet. 



S4 Zabriskie on Jltaxic and Intermittent Fevers. 

16th. His epigastrium is very tender upon pressure, he is very 
stupid, he has a difficulty of swallowing, tremor of the extremities, 
and a constant unintelligible muttering or groaning. Cups were ap- 
plied to the epigastrium, and acidulated drinks were given. 

17th. Complete coma, extremities are rigid, apparently a tetanic 
stiffness in the muscles. He is not able to swallow, is not roused by 
any thing except when pressure is made upon the epigastrium. His 
face is of a dark red or purplish colour, eyes red, hands and feet al- 
most cold, his pulse is small and slow. Cups were again applied, 
but without his appearing to feel them 

19th. He lies in the same state, complete incapability of swallow- 
ing, an ulcer upon his leg has sphacelated, and the rigidity is greater, 
his body is covered with petechia. 

90th. He died in the night. 

The tenderness of the epigastrium, and this tenderness continuing 
after the patient was comatose, and every other part insensible, ap- 
pear to point out the stomach as the seat of some extensive lesion, 
and the aggravation of the disease by purgatives appeared to indicate 
that this is the original disease, and that the other symptoms were 
sympathetic of this affection. The difficulty of swallowing was pro- 
bably owing to a rigidity of the muscles of deglutition, as it appeared 
at the same time and increased with the tetanic contraction of the 
muscles of the extremities. 

Case II. Mrs. Cephra, aged about fifty, the nurse of the house, 
having had a jaundice for four weeks, was seized on the 22d of May 
with a chill accompanied with nausea and occasional vomiting, pain 
in the back and extremities. She took a dose of senna and salts 
which operated powerfully. 

Q4th. The pain in extremities and back is better, but she still 
complains of the nausea and occasional vomiting. As she wished an 
emetic, which she stated she had been frequently in the habit of taking, 
I gave her one composed of ipecacuanha with a few grains of tartarized 
antimony. 

9.5th. The nausea still continues, and appears to be rather increas- 
ed since the operation of the emetic. She complains of pain in the 
stomach and head, of tenderness of the epigastrium, her eyes are red, 
tongue covered with a white fur, pulse quick. She had a considera- 
ble remission of her fever this morning, but towards evening her 
fever has increased, with quick pulse, hot skin, and thirst. Acid 
drinks, sinapisms to the feet, fomentations to the abdomen. 

9,7th. Less nausea. Her attendants state that she has much fever 
and is very delirious at night, very restless, tossing about conti- 



Zabriskie on •Ataxic and Intermittent Fevers. 85 

nually, yet through the day she is very much inclined to sleep. Her 
pulse is quick, skin hot and dry. The acetate of ammonia with a lit- 
tle laudanum was given through the night. 

28lh. Very sleepy, eyes red, tongue with red tip and brown cen- 
tre, she has a dull pain in her head, and for the most part lies asleep. 
Cups to the temples and epigastrium, acidulated drinks. 

29th. Tongue less red and moist, she has less pain, is not quite 
so soporose, otherwise the same. The same drinks continued. 

30th. The fever is very severe, the epigastrium very tender. She 
refused to be cupped again, as the slightest touch over her stomach 
gave her pain, and as leeches could not be procured a blistering plas- 
ter was laid over each hypogastrium. 

31st. Very stupid, the tongue brown, moist, red at the tip and 
edges, pulse small and slow, extremities cold. Calomel was given in 
a dose of five grains every hour for four hours. 

June 2d. Her tongue is dry and a very dark brown, nausea, 
thirst increased. She was confined to a solution of gum Arabic aci- 
dulated with lemon juice. This state continued, the symptoms grew 
more unfavourable, the coma increased, and she became more debili- 
tated till the fourteenth day of her sickness when she died. 

This case illustrates the effect of the purturbating treatment in 
ataxic fever. As the errors of erroneous practice may often prove as 
instructive as the details of that which has been more successful, I 
have introduced the above case, of which I took particular notes. 
The senna and salts produced a nausea and vomiting, which were in- 
creased instead of being relieved by the emetic. The stupor was in- 
creased, and the tongue rendered brown under the use of acetate of 
ammonia and tinct. opii, and the calomel instead of relieving the sys- 
tem of bile, made the tongue dry, increased the thirst, tenderness of 
the epigastrium, and nausea. Cups gave more relief than any other 
means, but the tenderness of the epigastrium prevented their use a 
second time, and leeches had not been obtained. The blisters pro- 
duced no good effect, and appeared to increase the heat, thirst, and 
gastric distress. 

Case III. John Laughen, thin, debilitated, with a constitution 
broken down by intemperance, was seized on the 20th of April with 
severe pain in his back and joints resembling rheumatism. Senna and 
salts. 

22d. He is worse, has had a chill followed by a sensation of heat 
and thirst. His pulse is slow, his trunk warm, extremities cooler 
than natural, tongue covered with a white fur, he complains of ten- 
derness and pain in the stomach, pain and heaviness of the head, and 



86 Zabriskie on Ataxic and Intermittent Fevers. 

a great disposition to sleep. Calomel was ordered to be given in five- 
grain doses every three hours. 

Q4th. Lies stupid except when aroused, his eyes are red, tongue 
dry, brown. After taking two doses of the calomel he refused to 
take any more, and now obstinately refuses to take any medicine. 
Cups were applied to the epigastrium and temples. 

25/A. The same. Appears very much disinclined to answer any 
question, tongue not quite so brown. Acid drinks were given him, 
which he drank freely. Blisters were applied to the epigastrium and 
temples. 

9!7th. More stupid, has taken the blisters oft' before they had any 
effect. Cups to the epigastrium, and the drinks continued. 

3 1st. For the last four days he has been confined to acid drinks, 
during which time the stupor has gradually disappeared, the tongue 
is becoming clean, and although he appears dull and very much de- 
bilitated, the symptoms have gradually subsided. He recovered upon 
a moderate diet. 

This man probably owes his life to his obstinacy in refusing to 
take medicine. From the bad effects of medicines in the former case, 
and the result of this, it must appear evident that the abandonment 
of the case to nature is the preferable mode of the two. 

Case IV. Eliza Peterson, aged twenty, athletic, robust, in the 
ninth month of her pregnancy, and expecting soon to be delivered, 
was attacked on the 17th of June with colic pains somewhat resem- 
bling labour. For this she took a dose of castor oil followed by an 
opiate, which relieved her for a time, but the next day it reappeared, 
and was again relieved by an opiate. That night she felt a severe 
chill, and the next day experienced the following symptoms: — Sleepi- 
ness, stupid expression of countenance, quick pulse, white tongue 
with red edges, thirst, great tenderness of the epigastrium, and pain 
upon pressure, pain and distress in the head, disinclination to answer 
questions. Acidulated solution of gum for a drink, and fomentations 
to the abdomen. 

18th, Very stupid, comatose, answers no questions, and is not 
much roused by anything except pressing upon the epigastrium, eyes 
highly injected, swallows drink when given to her, and has no dys- 
phagy or rigidity of the muscles. Not being able to procure leeches, 
and fearing to apply cups to the epigastrium as it was so tender, I 
was obliged to confine the treatment to acidulated drinks, fomenta- 
tions, and injections. 

Qlst. After continuing three days in the above state she appeared 
to amend a little, she answered some questions, and appeared more 



Zabriskie on Ataxic and Intermittent Fevers. 87 

easily roused. Fifteen leeches having been procured, were immedi- 
ately applied over the stomach, and before they fell oft* she appeared 
evidently better, she answered some questions rationally. Fomenta- 
tions were applied after the leeches. 

22d. Much better, has been sitting up, speaks rationally, eyes na- 
tural, tenderness of the epigastrium is almost gone, pulse more na- 
tural, tongue cleaning off. Mucilaginous drinks still continued. 

23rf. Convalescent. Has some appetite. Confined to a diet of ar- 
row root she rapidly regained her strength. 

Two weeks after this she was delivered of a small living child co- 
vered with a putrid bloody matter. 

This was evidently a case of gastritis, as shown by the great tender- 
ness of the epigastrium, the redness of the tip and edges of the 
tongue, and from the relief which was obtained almost immediately 
by leeching, and yet the cerebral symptoms ran as high as they could 
have done in any case depending upon cerebral origin. We see 
these also immediately relieved by the application of remedies for 
the gastric affection. 

Case V. Elizabeth Lewis, aged twenty, sanguine, gay, of a ple- 
thoric habit, after complaining a short period of languor, nausea, loss 
of appetite, was seized with severe pains in the bowels resembling 
colic on the morning of the 25th of June. To this succeeded a chill, 
followed by distressing pain in the head, and great somnolence. Her 
pulse was quick, tongue white with red tip and edges, she complain- 
ed that she could not keep awake except when aroused by pain, her 
stomach was very tender, eyes red, face flushed. She was bled six- 
teen ounces, confined to mucilaginous drinks, and fomentations were 
applied to the abdomen. 

26th. Feels much better. She says that the pain in her head and 
bowels with the somnolence and other symptoms left her soon after 
she had been bled. 

Case VI. Margaret Mercer, aged twenty-five, was brought to the 
house on the 29th of April. Her husband stated that she had had 
fever for some time, with a cough, pain in the chest, expectoration, 
and other symptoms of peripneumony. Two days before ske had 
taken a dose of calomel and jalap, which had purged her very much, 
and that she had been much worse ever since, becoming stupid. She 
now presented the following symptoms. Stupor, almost amounting 
to coma, redness of the conjunctivae, tenderness of the epigastrium, 
pulse quick, tongue white, cough frequent, little expectoration. Cups 
were applied to the epigastrium and chest, followed by fomentations 
and acidulated flaxseed tea for drink. 



88 Zabriskie on Jltaxic and Intermittent Fevers. 

30th. Much better, stupor relieved, expectorates more freely. 
Same drink. 

June 2d. The fever has left her. The cough continued for a short 
time, and she regained her health and strength. 

In this case the fever was evidently changed from synochal to 
ataxic by the purgative, and the good effects of local bleeding were 
immediately manifested. 

Case VII. Mary Schrceder, aged twelve, was seized on the 20th 
of June with a chill, followed by fever. She complained of nausea, 
pain in the head and stomach. She took some castor oil, which gave 
her some evacuations. On the 21st, when I saw her, I found her 
stomach tender, her pulse quick, her eyes red, tongue white, face 
flushed. She was very sleepy, and complained of pain in her head 
and back, of thirst, sometimes of nausea. In the morning she expe- 
rienced a great remission of these symptoms, the pain and somnolence 
were almost gone, the pulse was very little quicker than natural, 
and the heat disappeared. About 1 o'clock, P. M. these increased 
without any chill, she became sleepy, stupid, and delirious. She 
complained of pain and the other symptoms, which went on increas- 
ing till night. These symptoms continued five days under the use 
of acidulated mucilaginous drinks, fomentations to the abdomen, in- 
jections and absolute diet; during this period they gradually disap- 
peared, and she became convalescent. 

Intermittent Fever. — Although the doctrine that intermittent fever 
is owing to a local irritation has been extensively taught, and the 
practice of treating them by local means adopted by many physicians 
of France and other countries, still this practice is but little followed 
in this country. 

Almost every physician of extensive practice must have observed 
that local phlegmasia? often accompany intermittents, and especially 
inflammations of the lungs, liver, and stomach, that these phlegmasiae 
would often be aggravated by sulphate of quinine, bark, and other 
tonics, and that when means were used to reduce the phlegmasia?, 
the fever would disappear. The caution so often repeated by writers 
upon intermittent fever, not to give bark when there are symptoms 
of congestion of the lungs or brain, was founded upon observation, 
even by those who considered the fever as essentially constituting 
the disease, instead of considering it as the symptom of a local in- 
flammation. 

Boisseau says it is certain that chronic intermittents, and espe 
cially of the erratic kind, are generally the result of a chronic phleg 



Zabriskie on Ataxic and Intermittent Fevers. 89 

niasiae of the bronchia, lungs, or the pleura. That this is frequently 
the case there can be no doubt, but this fever is also symptomatic of 
other phlegmasia?. 

The following are a few cases of chronic intermittent, which re- 
sisted obstinately the treatment by sulphate of quinine, bark, and 
other febrifuges, but which were easily cured by local remedies. 
And where the fever did not immediately cease upon the use of local 
remedies, sulphate of quinine would immediately prove effectual, al- 
though it failed in the same cases before. 

Case I. Michael Trainer, aged twenty -two, of middle stature, 
dark hair and eyes, sanguine temperament, entered the house the 
21st of September with the following symptoms. He had a regular 
quotidian intermittent, commencing between 1 and 2 o'clock with a 
short chill of about an hour's duration, followed by a paroxysm of 
fever, which was not very severe, and was succeeded by a sweating 
stage, which lasted most of the night. In the morning he appeared 
much better, and ate his breakfast with considerable appetite. Dur- 
ing the cold stage he had a dry cough, which distressed him some, 
and he complained of a sharp pain in the right side upon taking a full 
inspiration. When he coughed during the night he expectorated. 
In the morning his cough was better. Percussion gave a dull sound 
over the lower part of the right lung; the stethoscope showed^the 
respiratory murmur extinct in the same part. He stated that he had 
had this fever for three months, and that during this time he had 
taken purgatives, emetics, bark, sulphate of quinine, and other febri- 
fuges in abundance, but without much benefit from any. Cups were 
applied to the right side of the chest, over the seat of the pain, and 
as he complained of costiveness, an ounce of castor oil was given to 
him. 

22d. Has had no fever to-day, and the cough and pain in his side 
is much better. 

%3d. Has had a slight attack to-day. Two more cups were applied 
to the right side. From this time his cough left him, and he has had 
no more fever. 

Case II. Patrick Martin, aged twenty-two, a tailor, with pale 
face, light eyes and hair, apparently enfeebled by long sickness, en- 
tered the house with an irregular chronic intermittent of six weeks 
standing. It attacked him every day, during the paroxysm he com- 
plained of a sharp pain in the side whenever he made a full inspira- 
tion. He expectorated a thick mucus. Percussion gave a dull sound 
in the right side of the chest. For this he had been blistered upon 
his side, and had taken the usual remedies for intermittent fever. 

No. XXV.— Nov. 1833. 9 



90 Zabriskie on Ataxic and Intermittent Fevers. 

Four cups were applied to the affected side. His fever immediately 
left him, his cough improved under the use of tincture of digitalis, 
and in a short time he left the house entirely well. 

Case III. Peter Stockholm, aged forty-three, tall, fleshy, of a 
sallow complexion, and leucophlegmatic habit, came to the Alms- 
house on the. 15th of August. He complained of tenderness of the 
epigastrium, of tightness across his chest, of a cough without much 
expectoration, a pain even upon drawing a full breath, his pulse was 
full, tongue white, with a reddish border. His fever was a regular 
intermittent, coming on about 12 o'clock with a short fit of shivering, 
and ending in a sweating stage at night. The febrile stage was not 
very violent. For this he had taken sulphate of quinine, bark, Fow- 
ler's solution, &c. without any benefit. Three cups were applied to 
his chest, and an acidulated solution of gum was given him for drink; 
under this treatment his fever immediately left him, the tenderness 
of the epigastrium disappeared, and his appetite returned, his cough 
however remained. But being unaccustomed to restrain his appetite, 
his fever again returned, and again yielded to cupping. A large 
blister was applied over his chest, and the tincture of digitalis given 
internally, his cough improved upon this, and for some time he was 
better. He has since, however, had frequent returns of fever and 
of his cough, and which cupping alone relieved. I have frequently 
given him sulphate of quinine, but without any benefit, and on the 
contrary, it produced a sense of stricture in his chest. 

Case IV. Sarah Griffith, aged forty-five, entered the house 28th 
of December with a regular intermittent fever, accompanied with a 
vioTent cough and a dull pain in the chest. The febrile paroxysm 
commenced every day with an ague, and passed through a regular 
hot and sweating stage. She expectorated a thick, purulent matter, 
and complained of pain in her chest upon coughing, her pulse during 
the apyrexia was weak, her tongue white. Cups were applied to her 
chest, which relieved her of her pain and improved her cough, but 
her fever continued. A few doses of sulphate of quinine broke this 
up immediately, and her cough left her. 

This case illustrates the remark, that although quinine is sufficient 
to break up a pneumonia accompanied with intermittent fever, and 
although at the same time would aggravate the cough and other local 
symptoms, still after these latter have been reduced, it maybe given 
with great advantage. Another case illustrative of this may be found 
below. 

Case V. Mrs. R. aged forty, of slender constitution, nervous tem- 
perament, was attacked on the 20th of September with intermittent 



Zabriskie on Ataxic and Intermittent Fevers, 91 

fever, for this she took a purgative of calomel and jalap, and some 
doses of sulphate of quinine, the fever immediately left her, her ap- 
petite became voracious, she felt an uneasiness in her right side, and 
in the course of a week had her fever again. This was treated in the 
same manner, she continued in this state for several months, her 
fever returning from the slightest cause, the distress in her side in- 
creasing, her skin became sallow, the conjunctivae tinged yellow. I 
found her in this state. She had a regular tertian intermittent com- 
mencing with an ague, during the days of the paroxysm she was con- 
fined to her bed, but during the interval she walked about and had 
some appetite. She complained of a tenderness of the right hypo- 
chondrium upon pressure, though not much pain, with some pain and 
uneasiness of the right shoulder, bitter taste of the mouth, white 
tongue with a slight tinge of yellow on the back part. A dose of 
calomel was given that evening, and followed by castor oil in the 
morning, and a large blister was applied upon the side. 

The pain is removed, she feels much better; this day being 
the period of apyrexia, twelve grains of sulphate of quinine were 
given. This treatment immediately broke up the fever, and instead 
of getting it every day, week, or fortnight, she has not had it for ten 
months. 

Bleeding in the cold stage of intermittents. — The practice of bleed- 
ing in the cold stage of intermittents was noticed in the medical jour- 
nals a few years since, and in several numbers of the American 
Journal of the Medical Sciences. Many physicians immediately com- 
menced the practice empirically, and with various success. Bleed- 
ing in every case, they succeeded admirably in some, while in others 
alarming symptoms ensued. This want of discrimination between 
those cases which were the proper subjects for this practice, together 
with its bad effects in certain cases, has led almost to the abandon- 
ment of a valuable resource in these fevers, instead of searching for 
the cause of the difference, and trying to find out in what cases this 
practice is proper. The same rules which respect bleeding in other 
cases apply here. In persons of a plethoric, full habit, with a strong 
pulse, who are not enfeebled by intemperance or by the fever, bleed- 
ing will often be found of great benefit, and especially if the fever 
puts on an inflammatory character. But where patients are enfeebled 
by intemperance, by the long continuance or the frequent recurrence 
of intermittents, and where the pulse is small and weak, general 
bleeding may give rise to alarming symptoms, and local bleeding is 
to be preferred. Having carefully noted a number of cases, I will 
subjoin a few. 



92 Zabriskie on Ataxic and Intermittent Fevers. 

Case I. Having had repeated attacks of fever, which often put on 
an inflammatory character, I determined to try this remedy. I was 
seldom troubled with nausea^ the tongue was generally white, and 
the pulse during the fever full and strong. I was bled during an 
ague, about twenty minutes after it had commenced, before the blood 
ceased to (low the ague ceased, and immediately after the operation 
I felt a glow of heat, and from that time the disease was conquered. 
I was not equally successful in all other cases. 

Case II. S. S. aged twenty-live, a person of an athletic constitu- 
tion, sanguine temperament, had suifered under a very severe attack of 
bilious fever in the autumn. Having recovered from this he was sub- 
ject to intermittent fever through the winter. He was much afflicted 
with pain in the head, often with nausea and vomiting of bile, and 
generally had an attack of the fever every fortnight or three weeks. 
His pulse was full and tense, tongue covered with a yellow or brown 
fur, and he often had great gastric distress. The sulphate of quinine, 
bark, and other febrifuges, would cut off the paroxysm, but would 
not prevent its return, although given freely in the interval. He was 
bled about half an hour before the expected return of the ague. It 
prevented it at that time, and it entirely left him. 

Case III. John S. aged about thirty-five, a man naturally san- 
guine, of a lively disposition, but whose circulation was now lan- 
guid, and whose strength much reduced by the long continuance of 
severe and repeated attacks of intermittent fever. He suffered much 
from pain and gastric distress, and his system was much debilitated. 
He fainted during the operation, so that I could get only a few ounces 
of blood. The bleeding did him very little good, except relieving the 
pain and distress to which he was subject. The fever continued as 
usual. 

Case IV. Mrs. S. the wife of the last mentioned individual, was 
bled at the same time with the best effect, entirely relieving her 
of her fever. She was of a sanguine constitution, with a full pulse, 
and other marks of plethora. 

Case V. E. Hendricks, aged twenty-eight, athletic, of a gross ha- 
bit, very strong and muscular, was also subject to frequent returns 
of intermittent fever. He had a great deal of pain in the head, nau- 
sea, and gastric distress, the fever put on an inflammatory character, 
the pulse was strong, and during the fever corded. He was bled so 
as to anticipate the paroxysm by an hour. It entirely relieved him, 
and his fever left him. 

Case VI. John Arr, aged forty, a man of intemperate habits, flo- 
rid complexion, choleric temperament, was subject to an intermit* 



Pancoast's Case of Empyema. 93 

tent fever, with a full and soft pulse, with much nausea and vomit- 
ing, and a? brown tongue. He was bled to the amount of fourteen 
ounces, when he fainted. The fever came on about two hours after- 
wards, and was very severe. During the fainting fit he was seized 
with violent spasms. Since the bleeding he has been subject to the 
fever as before, though with less pain. 

Case VII. A man, aged thirty-five, was very much reduced by fre- 
quent and severe attacks of intermittent fever, his complexion was sal- 
low, he was much emaciated and debilitated. He was bled just before 
an expected paroxysm. Before a sufficient quantity could be drawn he 
fainted, and was weakened without any benefit by the operation. 

Flatbush, New Fork, Sept. 14th, 1833. 



Art. VIII. Empyema cured by an Operation. By J. Pancoast, M. D. 

1 HE term empyema at the present day is restricted in its appli- 
cation to the collection of fluids in the cavity of the chest — air, water, 
pus or blood. The most common perhaps of these, and that which is 
most fatal usually in its issue, and which the term empyema more 
properly implies, is an effusion of purulent fluid. This may take 
place into the pleural cavity from several sources, and to which, from 
their yielding nature, the lungs readily give place. 

Abscesses of the mediastinum, vomicae of the lungs, or phlegmon- 
ous abscesses of the lungs or of the liver, may gradually, by perforat- 
ing the tissues which separate them from the pleural cavity, discharge 
their contents into it, and which they seem particularly disposed to 
do from the tendency to a vacuum produced in the thorax during the 
act of inspiration. A subacute inflammation of the pleura, either 
commencing in a latent form in a system, in which the sympathies 
are so obtuse, as not to reveal it, in its early stages, either to the pa- 
tient or his attendant, or an acute inflammation which ceasing to ex- 
cite pain, and to disturb the action of the organs, instead of disap- 
pearing entirely, has subsided into the chronic form. The serous 
membrane of the thorax, seeming to perform the office of a mucous 
lining, and to discharge gradatim, a purulent fluid, as we observe in 
coryza, fluor albus, and gonorrhoea. In both instances the secretion, 
though exhausting to the economy, is never directly fatal. In the 
latter instances it is discharged from the body through the natural 
openings, and hence all its disadvantageous consequences are com- 
prised in its formation. In the former they there only commence. 
The retention of the fluid is the greater evil, and which, par ex- 

9* 



94 Pan coast's Case of Empyema. 

cellence, when occurring in the cavity of the chest, constitutes 
empyema. The bulk of the fluid, besides the tendency to produce 
distress on account of its gravity, and to produce hectic symptoms 
by its absorption, displaces the heart and the lungs, and thus embar- 
rass the two most vital functions of circulation and respiration. 

In such cases the event must necessarily be fatal, unless the phy- 
sician not only obtains the discharge of the offending fluid, but takes 
such measures as shall prevent its excessive reaccumulation. 

In contemplating the chances of recovery from this disease, every 
thing will appear to depend upon the origin of the inflammation which 
gives rise to the secretion — whether it is an idiopathic affection of the 
pleura, the consequence of pleurisy or peripneumony, or whether it 
is secondarily induced by a neighbouring disease in the lungs or liver. 
In the latter case, the patient's situation is consequently more hope- 
less, as the primitive affection of these organs are too often of a kind 
that neither art or nature is able to combat against with success. 
The former cases, that is, those in which the pleura is principally the 
seat of disease, hold out the greatest inducements for the physician's 
exertion. In common pleurisy there is always, in the course of the 
disease, a greater or less amount of serum secreted in the cavity, and 
which is clearly distinguishable by any one accustomed to the use of 
the stethoscope by the characteristic sound of segophony to which 
it gives rise. This secretion is usually removed by absorption 
during the recovery of the patient, leaving the thorax nearly as free 
as before. But in cases where the disease is but illy cured, or the 
patient is too soon reexposed to the action of cold, a purulent secre- 
tion takes the place of the serous, and accumulates in one of the ca- 
vities of the chest to a very great extent. Such was the case with 
the patient whose history and cure I am about to relate below, and 
which may prove interesting to some of the readers of this journal, as 
I am not aware of the recent publication of any of a similar kind. 

"William Smith, aged twenty-two, a shoemaker by occupation, took 
a severe cold in the winter of 1828-9, which was attended with 
severe cough, painful respiration, pain in the left side, and -all the 
ordinary symptoms of pleurisy. He was relieved by his physician of 
the most urgent of these symptoms, but still retained throughout that 
season, a continued uneasiness in his side, occasionally aggravated, 
when he was more exposed to the inclemencies of the weather. At 
this period he continued at his work, as is usual with shoemakers in 
a heated stove room, not complaining much, but feeling occasional 
faintiness and shortness of breath, and walking, as his family ob- 
served, with his left shoulder so much depressed as to give him a lop- 



Pancoast's Case of Empyema. 95 

sided appearance. The succeeding summer he spent among his 
friends in the country, alternately better and worse, unable to attend 
to business, and apparently suffering with pulmonary consumption. 

The winter following, 1829-30, all the symptoms were aggravated 5 
he was confined to the house and subjected to medical treatment, but 
without any amelioration of his sufferings. 

About June, in the following summer, the dyspnoea and pain of 
the side were much aggravated. He grew unable to sustain even 
slight fatigue, and was obliged, after ascending a flight of stairs, to 
repose for some time on a bed. He was so little inclined to exertion, 
that the utmost importunities of his friends could scarcely, during 
the whole summer, persuade him out of sight of his own door. The 
hectic symptoms with which he had for some time been affected, were 
now fully confirmed. He had several flushes of fever during the 
day, and was usually bathed in a cold sweat at night. The soreness 
and pain of his side became concentrated in a spot, the size of a 
man's hand, between the tenth and eleventh ribs. Upon this spot, 
about the middle of July, he received a bruise, which was a little 
painful at the time, but soon overlooked. Shortly after this, an ex- 
ternal tumour was developed, the size of a common saucer; this was 
poulticed under the direction of a physician, and burst suddenly in 
the month of August, discharging according to the account of the 
family, about half a gallon of greenish fetid pus, with filaments of 
coagulated lymph. Exhaustion and syncope followed, and for a 
day or two he was in a state of excessive debility. The pain 
and oppression previously felt, was however much relieved by the 
discharge. 

I saw him for the first time in September; his side, which then 
presented three small openings, still continued to discharge drops of 
very fetid matter. The oppression and dysjfnoea had returned to a 
worse degree than ever, and his appetite, which had previously been 
tolerably good, now failed him. He could only sleep when propt up 
in bed, and inclined upon the diseased side, and then but for a short 
space of time. Besides, hectic fever and sweats were fast dissipating 
the little strength he had left. He had a ticking sensation in his 
head, for which lie had been directed by a physician a short time be- 
fore to be bled, but which afforded no relief. 

Upon examining the thorax, the ribs of the left side w'ere found 
much sunken, measuring about an inch and a half less from the spine 
to the sternum, than those of the other side. The lower angle of the 
scapula w T as very prominent, the spine incurvated, the shoulder 
sunken, the heart palpitating in the right half of the thorax, where it 



98 Pancoast's Case of Empyema. 

seemed to have been forced by some fluid in the left. The whole of the 
left half of the thorax, except a small part below the clavicle in front, 
sounded dull, and with the stethoscope no respiration could be heard 
on that side, except near the clavicle. The right lung upon ausculta- 
tion appeared healthy, but more resonant than usual, in consequence 
of the increased duty it had to perform from the useless condition of 
the other lung. 

The symptoms of the case, connected with the fact of the previous 
discharge of purulent matter, left no doubt of a large accumulation 
of some similar fluid. The patient was nearly exhausted by the 
length and obstinacy of the affection, and therefore to prolong his 
life even for a short time, it seemed necessary to retort to some 
means of removing the secretion. 

Pus, when thus collected in the chest, unlike the serous effusions, 
is scarcely ever removed by absorption. The successive increase of 
the fluid reacts upon the membrane which forms it, and thus keeps 
up a perpetual irritation and a perpetual flow. If not withdrawn 
from the body, it compresses the lungs against the mediastinum, and 
destroys the patient by suffocation, or wears him out by the irritation. 

Nature in some instances makes an effort for its discharge. An 
opening may be formed by ulceration through the pleura pulmonalis 
into one of the bronchia of the lung, and the matter be discharged by 
expectoration. In such cases, though relief for the moment is at- 
tained, the air in respiration makes its way into the cavity of the 
chest, becomes a new cause of irritation by its oxygen acting upon 
the pus, and in a short time the patient dies. 

Another process of nature, and which is sometimes attended by 
success, is a tendency to point or form an opening externally through 
the parietes of the chest. This process has been imitated by the 
hand of art, making an incision through the walls and discharging 
the fluid. But the air is apt here to pass in at the external wound 
and take the place of the secretion, and thus keep up an irritation, 
which, in the course of a month or two usually destroys the patient. 

Dupuytren has asserted, that out of more than fifty cases in which 
he had operated, he could quote but two instances of success; and 
Sir Astley Cooper, that he had never observed one. 

Dupuytren has subsequently pursued a different plan, and which 
has proved much more successful. An analogous course has also 
been pursued by Baron Larrey. Its merit consists in an evacuation 
of the fluid without the introduction of air. This is done by the 
skin being first drawn upwards, and a trochar then pushed into the 
cavity, the fluid evacuated, and the skin allowed to take its natural 



Pa nc oast's Case of Empyema. 97 

position, and thus to close the opening. In this manner the opera- 
tion is to be repeated at intervals of several days, as long as the 
fluid continued to accumulate. 

In reflecting upon this case, it was evident that nature had done 
all that she could do towards the recovery of the patient, in giving 
the matter an external direction, and having caused a copious dis- 
charge. An operation now seemed required. It appeared to me, 
that even in the present emaciated and exhausted state of the patient, 
the chances of the patient's recovery was still probable, if the matter 
could be discharged without the introduction of air. The sinuses 
which had been left since the discharge in August, were found on 
probing to be very sinuous, and though they must have communicated 
with the internal abscess, a slow stillicidium of pus took place through 
them, and appeared to prevent the passage of air inwards. I there- 
fore determined, in preference to Dupuytren's plan of repeated tap- 
ping to imitate nature by making a valvular incision into the cavity, 
and keeping it open by the frequent introduction of a catheter in an 
oblique direction. By this means I should be enabled to evacuate 
the fluid as it was secreted, and thus by preventing distention again, 
allow the diaphragm a better chance to ascend, the lung to expand, 
and the ribs to fall inwards, so as to diminish the cavity of the ab- 
scess. 

On the 27th of September, with the assistance of my friend, Dr. 
Condie, I made an incision in the middle of the space between the 
tenth and eleventh ribs, down to the pleura, and through this, which 
was covered on its inner surface with a thick coat of false mem- 
brane, a female catheter was pushed. About two quarts of pus with 
some odour was discharged in jets synchronous with the pulsations 
of the heart. The wound was then carefully closed, covered with a 
large piece of adhesive plaster and a compress, and the whole sur- 
rounded with a roller bandage. The patient was directed an infu- 
sion of bark and snakeroot, and the use of weak wine whey. The 
laborious breathing and the extreme general anxiety was immediately 
relieved. No faintness occurred from the discharges. In the course 
of a day or two the appetite was improved, the hectic symptoms much 
diminished, and natural slumber returned; at first daily, and subse- 
quently at intervals of two and three days, I introduced a female 
catheter from the bottom of the wound obliquely upwards, to dis- 
charge the secretion, which usually amounted to from two to three gills. 
On the fourth day after the operation the heart had nearly resumed its 
natural position, and I discovered by the stethoscope, that air pene- 
trated into the lungs two or three inches below the clavicle When 
the stethoscope was applied upon that side near the spine, the voice 



98 Pancoast's Case of Empyema. 

of the patient when he spoke appeared to come with great force 
through the tube, indicating that there was still within a large unoc- 
cupied cavity. 

December 4th. — Saw him again with Dr. Condie, every way im- 
proved; no night sweats; sleeps well; feels no pain; breathes easy. 
Introduced catheter again, and took away half a pint of bland serous 
pus. Heart regained its natural position. By the stethoscope, we 
discovered that air now passed down the left lung for four or five 
inches below the clavicle. When the stethoscope was placed close 
to the spine, any where opposite the thorax, a faint sound like the 
tintement metallique was occasionally heard. It was also heard at 
times two or three inches below the outer margin of the clavicle. This 
at one time gave rise to the opinion that there was a fistulous commu- 
nication between the lungs and the cavity of the pleura. It was more 
probably owing to the plastic matter covering the pleura giving way 
during the partial expansion of the lung. Broncophony very strong 
below the clavicle; and during respiration there was occasionally 
heard a sound down the spine like the bleating of a goat, (segophony.) 

7th. The weather had suddenly changed, and the patient had been 
exposed to currents of air; countenance paler; spirits sunk; pulse small, 
palpitation of the heart heard more distinctly than before, all over the 
left chest. Respiration much less distinct in left lung than at last visit. 
Introduced a gum elastic catheter, as the canal had become too wind- 
ing for the silver, and took away half a pint of fluid, same colour and 
consistence as before. Directed the patient to be placed in a warm 
stove room, to be more warmly clad, to have his chest well rubbed 
with a strong liniment, and to take his tonic medicine more freely. 

10th. Patient much improved; rests better; but has had considerable 
night sweats; respiration could now be heard in the left lung, six 
inches below the clavicle, and down the whole length of the back; re- 
moved about half a pint of thin puruloid secretion. No pain on the 
introduction of the catheter. From this period he continued regu- 
larly to improve; the lung slowly expanding, and the quantity of se- 
cretion becoming less and less; care was taken to keep the orifice 
open, and a small catheter was introduced once a week, by twisting 
it through the winding canal, into the cavity of the chest. The 
amount taken away was usually about a gill. Whenever a cold 
change of weather ensued, or the patient was more than usually ex- 
posed, the quantity was increased. The following Juue he was ex- 
posed to a shower of rain, and suffered from an attack of catarrh, to 
which affection he had for some time seemed very much disposed. 
While this lasted, the discharge consisted of thick bland pus, about 
three gills of which were evacuated every four days. 



Pancoast's Case of Empyema. 99 

Counter-irritation was continually kept up upon the chest. After 
the tartar emetic eruption had disappeared, blister plasters were ap- 
plied alternately to the back and front of the chest. Tonic remedies 
were continued. The patient walked and rode every day when the 
weather would permit. 

July \st. — Examined him very attentively again with the stethos- 
cope and pleximeter. Both indicated the presence of fluid at the 
bottom of the left pleural cavity. A mucous rhonchus was heard in 
the left chest like that of catarrh ; and at the end of every inspiration, 
and sometimes in the middle, a sound like that of ek, pronounced in 
a strong inspiration. The left shoulder was considerably sunken; 
the spine was considerably curved with the convexity to the right 
side. The left side of the chest measured one and a half inch less 
than the right. 

During the latter period of the treatment, when, from the develop- 
ment of the lung, rising of the diaphragm, and the reoccupation of 
its proper position by the heart, the superficies of the abscess was 
much diminished, I tried the measure advised in such cases by Dr. 
Cartwright, of Natches, to avoid the trouble and pain, arising from 
the frequent partial introduction of the catheter to prevent the sinus 
closing its whole length." This measure, (see this Journal, Vol. 
Vol. VII. p. 413,) consists in the introduction of a bent wire 
into the cavity of the abscess, to act as a sort of syphon, by producing 
a discharge guttatim of the matter within. I found it difficult with 
it to exclude the air, it appeared also to irritate the lining membrane, 
and I was obliged to abandon it, and trust to the former mode which 
had proved successful. 

From this period the patient continued to improve. In the autumn, 
a year after he came under my care, he was able to resume his occu- 
pation. The sero-purulent secretion however still continued to form 
for near a year longer, and the patient's mother was in the habit every 
week or ten days, of introducing a catheter, and evacuating it to the 
amount of three or four ounces. As the amount decreased consi- 
derably, the canal for the first time was allowed to heal throughout 
its whole extent, for the first time in August 1831. At the present 
time the patient is in the enjoyment of as good health, and nearly as 
able to undergo fatigue as at any previous portion of his life. 

The gratifying results of the treatment of this case of empyema, 
a result so seldom met with when paracentesis thoracis is performed, 
appears due in part to the youth of the patient, and to the recupera- 
tive efforts which nature had already made, in effecting a discharge 
externally. But a great deal still appears to be owing to the valvu- 
lar opening which was made, and kept open for so long a period, by 



100 Mitchell on the Penetration of Gases. 

which we were enabled to keep the secretions from accumulating in 
the chest, and thus allowing the walls of the immense abscess to ap- 
proach each other, and finally to obliterate the cavity. In the num- 
berless introductions of the catheter, a single bubble or two of air 
was the most ever allowed to enter, and then at the moment of its 
withdrawal. I note this case in hopes that this process may be 
thought worthy of a trial, by some more experienced hand. 

A case of abscess of the chest, of some interest, occurred a few 
years ago in the upper part of this state, in the practice of a medical 
friend, and was cured in a way somewhat unique, which would seem 
to make it worthy of recital. 

A man was seized with some affection within the thoracic cavity, 
which resisted the prescriptive treatment of his physician. The 
stethoscope at that period had not come into general use, and the 
case was so ambiguous, that its character was not revealed by its 
symptoms. The patient and his friends entertained the opinion, that 
he was labouring under pulmonary consumption. No swelling, no 
discoloration, existed- externally upon the thorax; but the patient, 
from the internal sensation produced by the disease, had a settled 
conviction that there was a gathering within. Taking a seat by an 
unfrequented side of the house, he plunged the blade of his penknife 
opposite the seat of pain between the ribs. He was found with pus 
flowing from the wound; a large quantity was discharged from the 
narrow wound. From that time his symptoms were relieved, and the 
patient finally recovered. 



Art. IX. On the Penetration of Gases. By J. K. Mitchell, M. D. 
Professor of Chemistry, &c. in the Franklin Institute, and Lecturer 
in the Medical Institute. 

IN the November No. of this Journal for 1830, I published a paper, 
on the force and ratio of transmission of gases through membranes. 
The subject has since that period attracted much attention, both here 
and in Europe, and the experiments then made, have become the 
basis of reasoning on many morbid phenomena, and some physiologi- 
cal functions, particularly that of respiration. These considerations 
have led me again to review the experiments made at that time, and 
to make others, which seemed necessary to the full elucidation of the 
subject. This labour became the more necessary, since Mr. Graham, 
of Glasgow, a chemist of growing reputation, has, in the course of an 
experimental investigation of the transmission of gases through stucco 



Mitchell on the Penetration of Gases* 



101 



plugs and other inorganic substances, confounded together two very dif- 
ferent actions, and thus thrown some obscurity over the whole subject 
In 1829 I believe* Mr. Graham attempted to ascertain with accu- 
racy the law by which the gases intermingle, or are diffused through 
one another. Mr. Dalton had previously shown, that when two gases 
of different specific gravities are placed in contact, so that the heavier 
gas shall be beneath the other, they notwithstanding, gradually com- 
mingle, even if fa long narrow tube be the only connecting medium 
between their respective reservoirs. These and other facts led Mr. 
Dalton to conclude that each gas is repulsive only of itself, and that 
its interstices are a vacuum for the reception of any other gas what- 
ever. The fallacy of that view of the subject might have been made 
out by the fact, that the commingled gases occupy as much space as 
when existing separately, and therefore cannot be supposed to enter 
the interspaces of each other as into a vacuum. The first experiment 
however, which demonstrated the error, was that recited in my first 
paper, showing that the force of 'diffusion,' as well as of 'penetration,' 
exceeded by an unknown quantity, the pressure of two atmospheres. 
Mr. Graham, by confining gases in vessels communicating with the 
air by narrow apertures, found that the ratio of diffusion varied in- 
versely as the square root of the density. In a paper read before the 
Royal Society of Edinburgh on 19th of December, 1831, more than 
a year after the publication of my paper, Mr. Graham describes a 
series of experiments on « diffusion,' made by the intervention not of 
artificial apertures, but of plugs of stucco in which the pores are mi- 
nute enough to oppose a slight resistance to the mechanical escape of 
aerial fluids. By placing various gases in a glass vessel closed at 
one end by a stucco plug, and resting on mercury or water, and ob- 
serving the time taken to escape, and the volume of reentered atmos- 
pheric air, he formed the following table. 

Table of Equivalent Diffusion Volumes of Gases, air being 1 or Unity. 







Specific Gravity. 




3.83 

1.344 

1.0191 

1.0149 

1.0143 

0.9487 

0.95 

0.82 

0.812 

0.68 


0.694 

0.555 

0.972 

0.972 

0.972 

0.111 

1.1805 

1.527 

1.527 

2.222 


Carbureted hydrogen - - - - - 
Olefiant gas 

Carbonic oxide --.'*."-.. 


Oxygen „„_-. 

Sulphureted hydrogen 

Protoxide of nitrogen - - - - - 
Carbonic acid --»-.--- 
Sulphurous acid 



Thus his former conjecture was confirmed, and he appears to have 
No. XXV.— Nov. 1833. 10 



102 Mitchell on the Penetration of Gases. 

proved that « diffusion' is inversely as the square root of density. As 
the pores of stucco, charcoal, paper, &c. are penetrated with great 
ease by the gases, the quantity constantly presented at the surfaces 
of the stucco is greater than the diffusive power is capable of convey- 
ing away, hence only the « diffusion ' can be thus exhibited, since the 
amount of * penetration ' is limited to the quantity removed by the 
air. The removal more rapidly by a current or a vacuum, greatly 
increases the amount effused, showing the much greater 'penetration.' 
Substantially in the former paper, I stated that. when the ' penetra- 
tion' exceeded the ' diffusibility,' only the latter could be measured, 
whereas, when the diffusion is greater than the penetration, it is the 
action of the barrier which is estimated. Overlooking this distinc- 
tion, Mr. Graham has confounded together all kinds of penetrable 
barriers, and asserts that " dried bladder answers for showing the 
diffusion of hydrogen when stretched over the open end of the tube 
receiver; the diffusion however, through a single thickness of bladder 
is effected at least twenty times more slowly than through a thick- 
ness of one inch of stucco; while on the other hand, either air or 
hydrogen, under mechanical pressure passes more rapidly through 
bladder than through a great thickness of stucco. Goldbeaters' skin 
is even more permeable by gases under slight pressure than bladder, 
and less suitable for diffusion." pp. 240, 241. That Mr. Graham 
has fallen into unaccountable error in this particular, is demonstrable 
by the following simple experiment. 

Over the end of a tube eight inches long was tied a piece of moist- 
ened bladder, which was subsequently dried. The tube was then 
filled with mercury, and placed erect on the mercurial pneumatic 
shelf, by the side of a similar and similarly treated tube closed with 
stucco. In less than three minutes the air had passed through the 
stucco, and followed the mercurial column down to the level of that 
in the trough. In the other, in twelve hours, enough of air had not 
entered through the bladder to disengage the mercury from its con- 
tact with it. It amounted to a small bubble floating about against the 
under surface of the bladder. To secure to the bladder complete 
contact with the glass, it must be tied on when wet, with a dry waxed 
string, and then left some hours to dry. Any tube thus treated will 
admit air by mechanical impulsion many thousand times more slowly 
than stucco of an inch in thickness. When it does otherwise it is 
unsound or imperfectly tied on. Whenever the hydrogen finds its 
way out by a passage between the glass and bladder, it diffuses more 
rapidly than carbonic acid, and only then. 

Another experiment made with a different object demonstrates the 
same fact. Three tubes each six inches in height and capable of 



Mitchell on the Penetration of Gases. 103 

holding two cubic inches of air were closed with bladder at one end, 
and filled half-full of nitrogen, hydrogen and oxygen respectively, so 
that each tube being placed over water, held a column of that liquid 
nearly three inches high. Notwithstanding the pressure inwards, 
the tubes all of them fully supported the columns, and at the end of 
five days they all contained less air and more water than at the be- 
ginning. No stucco plug would support a three inch column of water 
for five minutes. 

Notwithstanding these discrepancies, I thought it important to go 
again into an examination of the ' penetration' of gases, and to write 
on the subject a series of papers, of which this, the first, will contain 
little more than an experimental review of ground formerly, but 
hastily traversed. The great importance of the subject, seem to 
me to justify the repetition of the experiments which will be report- 
ed more in detail than the former ones. 

The annexed wood cut represents the inverted syphon with which 
a great many of the following experiments were -p. . 

made. Enlarged at one end into a kind of funnel ^-- : ---?:*--W 
or inverted cone, ^ ths of an inch in diam eter, over 
which the membrane is tied, its other limb -f- ths 
wide, is graduated into divisions of equal lengths, 
of the capacity of 0.003 of a cubic inch. Under 
the membrane were placed 0.075 of a cubic inch ; 
of atmospheric air, which was confined there 
by mercury having the same level in both limbs ■ 
of the syphon. Thus prepared, the funnel of the syphon was pressed 
under mercury and brought up into a bell-glass, holding two and a 
half cubic inches of the gas to be tested. The rise of the column of 
mercury in the outer limb indicated the velocity of influx, and the 
quantity. In the first series of experiments exhibited in the follow- 
ing table, gum-elastic was used as the barrier. Its flexibility when 
dry, its refractory character, its feeble hygrometric power, well fit it 
for a standard of comparison.* The whole of the experiments ar- 
ranged in the first table, were made with the same membrane, so 
that, making allowance for the effect of dust, mercury, and the irre- 
gular manner in which quicksilver moves in a narrow glass tube, the 
various results by the same gas are very uniform. 

• In a very thin, transparent bag* of gum-elastic were placed g4. jij. 57 grs. 
of water, which lost in weight per day as follows:— 8 grs., 4 2-3, 6, 3 3-5, 4£, 
3£, 3£, 3£, 2, 0, 2§, 2, 2, If, &c. The average loss for one hundred and 
twenty-nine days was 2.367 grains per day. 

A section of bladder tied up in the form of a bag, and holding 4oz. 65. 2 grs. 
of water lost per day 259 grains, 117, 303, 621, when it became offensive. 



104 



Mitchell on the Penetration of Gases, 



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Mitchell on the Penetration of Gases. 



105 



The average rate of penetration is inversely as the following num- 
bers. 

Sulphureted hydrogen, 1; cyanogen, 1.1 665 ammonia, 1.75; car- 
bonic acid, 4.50; hydrogen, 15; oxygen, 35; or taking the least 
number of each column, we have — sulphureted hydrogen, 0.85; 
cyanogen, 1; ammonia, 1.25; carbonic acid, 4.233; hydrogen, 14.75; 
oxygen, 32. As these numbers are also inversely representatives of 
the quantities of the gases admitted in equal times, it follows that 
nearly fifteen times as much cyanogen enters in a given time as of 
hydrogen, whereas according to Graham, hydrogen should enter in 
about four times the measure of cyanogen. 

In the instrument, Fig. 2, some of the gases were compared, so as 



Fig. 2. 




to verify the results of the first 
table, the intervening membrane 
being also gum-elastic. The in- 
strument consisted of two hollow 
cylinders of iron or brass with 
flanges and screws so that they 
might be forced into powerful con- 
tact. To accomplish this the^f 
better, the screws had perforated' 
heads through which a lever could be passed. Between the shoulders 
of the cylinders, was placed the membrane, and by means of the 
screws and levers, the shoulders of the cylinders tightly compressed 
the membrane, so as to entirely cut off communication with the air at 
the point of contact. Into the cylinders were fixed by sealing wax 
curved glass limbs, of equal length and diameter, so that when put 
together the whole represented an inverted syphon open at each end, 
but separated into two compartments by the membrane at its middle 
point. By placing measured quantities of the gases to be compared, on 
opposite sides of the membrane, the experiment commenced under 
perfectly equal circumstances. The quantities were alike, they were 
on the same level at the membrane, and were subject to equal causes 
of tension. But few observations were thus made on gum-elastic, 
and these merely to verify the results presented by the funnel-syphon. 
Carbonic acid was found to be more penetrant than hydrogen, hy- 
drogen than oxygen, and oxygen than nitrogen, made both by phospho- 
rus and hydrogen. The exact degree was, for want of time, over- 
looked. 

Another general verification was made in simple tubes standing 
erect over mercury or water, and covered with the same kind of mem- 
brane. In these cyanogen was more penetrant than carbonic acid, 
that than hydrogen, that than oxygen, and nitrogen scarcely ever 

10* 



106 Mitchell on the Penetration of Gases. 

suffered any other change than that produced by alteration of tempe- 
rature. In the next paper more exact results will be given. 

Before proceeding to the action of gases on wet animal membranes 
and recent animal tissues, some observations were made on dry 
bladder. A tube Fig. 3 was filled to the top with mercury — after 
Fig. 3. standing over the mercurial trough all night* a very small 
bubble of air was observed among the mercury yet in 
contact with the membrane. A similar tube closed with 
a plug of stucco an inch in depth suffered the air to enter 
so rapidly as to let the mercury fall to the level of that 
in the trough in a few minutes. Having ascertained in 
this manner the tightness of the membranous coverof three 
equal tubes, a cubic inch of hydrogen, oxygen and nitrogen 
respectively was placed in them. By transfer to water 
that liquid took the place of the mercury without wetting 
the membranes. After five days the hydrogen was less 
by 0.38 of a cubic inch, the oxygen by 0.08, and the ni- 
Gt trogen 0.015. Stating the rate of hydrogen as in the 
S====f^B i s t table at 15. that of oxygen will be 3.158, and of ni- 
troo-en 0.58: or hydrogen penetrates nearly five times as rapidly as 
oxygen, and that nearly six times as rapidly as nitrogen, when dry 
bladder is used for the cover, and the gases stand over water. 

A syphon, Fig. 2, contained in its limbs 125 parts of hydrogen and 
carbonic acid respectively. A perfectly dry bladder intervened, and 
was compressed by the shoujders of the iron as forcibly as possible. 
At the end of twenty-four hours, of the 125 parts of hydrogen 2 pass- 
ed to the carbonic acid through the membrane, 51i by the space be- 
tween the iron shoulder and bladder to the air, and by the same way 
there reentered 30|ds of common air. 

Of the 125 parts of carbonic acid 5 passed through to the hydro- 
gen, 30s passed by the side of it to the air, and the reentered air 
measured &5|. 

Penetration through dry bladder — hydrogen 2, carbonic acid 5, or 
1 to 2.5. 

Diffusion by the side of the membrane — hydrogen 51.5, air 30.666, 
or 1.68 to 1; carbonic acid 30.5, air 25.5, or 1.196 to 1. 

Experiments on the penetration of gases through wet and recent 
animal tissues. 

The syphon, Fig. 1, used for the experiments arranged in Table I. 
containing the same quantity of atmospheric air, was covered with 
bladder soaked in water until perfectly infiltrated, and then wiped 
dry on the surface. It then, by immersion in the following gases.*, 
gave the results stated in Table II. 



Mitchell on the Penetration of Gases. 

TABLE II. 

Rates of Penetration through wet Bladder in Syphon, Fig. 1. 



107 





Ammo- 


Ammo- 


Cyano- 


Cyano- 


Carbo- 


Carbo- 


Hydro- 


Hydro- 


5 


nia. 


nia. 


gen. 


gen. 


nic acid. 


nic acid. 


gen. 


gen. 


d 




d 




d 




d 




d 




d 




d 




(X 




a 




a 


QJ 


£ 


o 

0> 


S 


o 


e 


o 


£ 


o 


S 




F 


c 






CO 




co - 




CO 




CO 


h 


CO 


h 


CO 


0) 


S 




S 


1 


72° 


8 


72° 


11 


71° 


49 


69° 


50 


69° 


224 


71° 


228 


72° 


38 


70 


37 


2 




12 




10 




66 




62 




214 




194 




30 




34 


o 
O 




11 




9 




55 




48 




193 




192 




31 




31 


4 




8 




8 




46 




44 




158 




193 




37 






5 




10 




10 




54 




51 




228 




225 









Ratio— 1 to 5.5—20.7—600. 



TABLE III. 



Hate of Penetration through the Crop just taken from a Chicken, and tied over the 
end of the Syphon, Fig. 1. 



O 


Ammonia. 


Ammonia. 


Ammonia. 


Cyanogen. 


Cyanogen. 


Carbonic 
acid. 


d 
S 

H 


o 

CO 


d 
£ 

H 


d 

CO 


d 

£ 
<u 


o 

CO 


d 
£ 

H 


d 

CO 


d 
£ 

H 


d 

<u 
CO 


d 
£ 
ft 


CO 


1 

2 
3 
4 
5 


72° 


8 
10 
14 
18 


71° 


8 
10 
14 
18 


73° 


8 
6 
5 
5 

8* 


71° 


45 
43 
41 

27 

47 


69° 


55 

46 
36 
28 
42 




156 

139 

95 

115 

137 



Ratio— 1 to 4—12.3. 

The piece of paper containing the account of the experiments on oxygen 
for Table II. and of oxygen and hydrogen for Table III. having been mislaid, I 
am able to recollect merely the general agreement exhibited by the other 
gases. Oxygen penetrated somewhat more slowly than hydrogen. 

Experiments on the penetration of gases through wet and fresh ani- 
mal tissues in the inverted syphon, Fig. 2. 

1st. Over mercury 0.85 of a cubic inch of carbonic acid and oxy- 
gen from nitre were placed in the opposite limbs of syphon, Fig. 2, 
separated from, each other by wet bladder. In twenty-five hours the 
carbonic acid was lessened to 0.355, which lost by washing 0.330, 
leaving behind 0.025 of oxygen. The contents of the other limb were 



* Immediately after an experiment with any gas, a repetition with the same 
membrane and gas usually showed acceleration. 



108 Mitchell on the Penetration 0/ Gases. 

lost without admeasurement, but were greater than at the beginning 
of the experiment. 

2d. Repeated. 1.10 parts of carbonic acid, 0.85 parts of oxygen, 
after twenty-one hours found the carbonic acid reduced to 0.63, 
which lost by washing 0.605, leaving 0.025 for the oxygen sent 
through. . , 

The other limb contained 0.965, lost by washing 0.30; 0.30 of car- 
bonic acid and .025 of oxygen went through the membrane, which 
held in its pores 0.195 carbonic acid and 0.155 oxygen. Or carbonic 
acid is ten times as penetrant as oxygen. 

3d. Repeated. Carbonic acid 1.35, oxygen 0.85, after a lapse of 
nineteen hours and fifteen minutes the gas in the carbonic limb was 
0.88, lessened by washing to 0.05; while the other limb contained 
1.125, reduced by washing to 0.785 — so that 0.34 of carbonic acid 
penetrated, and 0.18 were absorbed; while 0.05 oxygen penetrated, 
and 0.015 was absorbed; or carbonic acid is more than six times as 
penetrant as oxygen.* 

4th. Repetition. Substituting fresh chicken crop for the wet blad- 
der — 1.35 of carbonic acid, and 0.85 of oxygen — time, twenty-seven 
hours and thirty minutes. The carbonic acid limb contained 0.35, 
which by washing was reduced to 0.05; the other limb held 1.55, re- 
duced by washing to 0.80— so that 0.75 of carbonic acid and 0.05 
of oxygen penetrated, while the membrane held 0.50 of acid, and 
none of the oxygen. According to this experiment, carbonic acid 
penetrates fifteen times as rapidly as oxygen. 

In the same syphon, Fig. 2, by the intervention of wet bladder, 
hydrogen and cyanogen were compared. In these experiments 
equal quantities were used. The column of mercury rose in the 
limb containing cyanogen, and fell in that holding hydrogen, thus in- 
dicating the superior penetrancy of the heavier gas. 

2d. Repeated. The hydrogen received twenty parts of cyanogen, 
and transmitted only one part. 

3d. Repeated. Twenty-eight parts of cyanogen, and nearly one 
and a half of hydrogen permeated the wet bladder. 

1 st. Hydrogen and nitrogen compared over water by wet bladder. 
Time nine or ten days; instrument, Fig. 2; quantity 2.55 of each; 
temperature ranged between 69° and 78° Fahr. By Hare's eudi- 
ometer the hydrogen was shown to hold 0.289 ot nitrogen, the nitro- 
gen 0.50 hydrogen, hydrogen therefore penetrated 1.724, nitro- 
gen 1.0. 

* After observing" the great amount of absorption by the wet membrane, I 
increased the proportional quantity of the more absorbable gas. 



Mitchell on the Penetration of Gases. 109 

1st. Comparing oxygen and hydrogen in the same manner with 
intervention of fresh crop — after two days the greater penetrancy of 
hydrogen could be seen by the change of volume, which was not how- 
ever very considerable.* 

Experiments to ascertain the full result of penetrant action through 
wet bladder. 

To effect this object, a syphon similar to that represented in Fig. 
1, was so adjusted, that its outer limb at A being made short, it 
could discharge the mercury in proportion to the influx of gas at the 
other end, without very materially altering the pressure. The mer- 
cury discharged represented the quantity of aerial influx through the 
membrane, or rather the difference between the penetrant action of 
air and the gas. The wide end of the syphon contained 0.25 parts 
of a cubic inch of air, the bell-glass nearly a pint of gas. The first 
experiment was made with ammonia at the temperature of 69° Fah. 
After a lapse of between thirty minutes and an hour in all cases, the 
ammonia seemed to cease action, and the quantity of mercury thrown 
out, was in three different cases 1.025, 0.90, and 0.975 respectively. 

Cyanogen. Under the same circumstances took at least eight hours 
to complete its action, and the quantity of mercury thrown out varied 
from 0.90 to 1.00. 

Carbonic acid did not cease action for nearly three days, when it 
was found that 1.125 parts of mercury were discharged. 

In a second experiment .555 parts were discharged in twenty-five 
hours; in the next twenty hours and fifteen minutes, 0.15; in the next 
twenty-four hours and ten minutes, 0.075; and in the nineteen hours 
and thirty minutes immediately preceding the cessation of action, 
0.02. Total, with correction for temperature and pressure, 0.98, in 
about three and a half days. 

Hydrogen under a similar arrangement discharged 0.045 in eleven 
hours and fifteen minutes; 0.025 in seven hours and fifteen minutes; 
0.045 in sixteen hours; 0.07 in twenty-live hours and fifteen minutes. 
Total after correction, 0. 205, in fifty-nine hours and forty -five mi- 
nutes, at which time an accident put an end to the experiment, while 
it was yet in action. From the experiments immediately antecedent, 
it is probable that the amount would finally have reached about 0.95 
to 1.00, or a cubic inch; or, as in the other cases, 0.25 of air would 

* In the last two experiments nothing is certain but the greater penetrancy 
of hydrogen over either oxygen or nitrogen, for the motion in the limbs of the 
syphon showed that. In both, the bladder began to spoil at the end of the ex- 
periment. 



110 Mitchell on the Penetration of Gases. 

mingle with 1.00 of gas, the proportion being about 4 to 1, as in the 
mixture of nitrogen and oxygen in the atmosphere. The penetration 
of air through wet membranes is so slow, as to leave scarcely a trace 
of such action by analysis, even in the most protracted experiments. 
I have therefore made my calculations without introducing it. 

From these experiments it appears that the rate of in Jux was very 
great or rapid for ammonia, much slower for cyanogen, still slower 
for carbonic acid, and very slow indeed for hydrogen. Ammonia 
completed in half an hour the penetration which required eight hours 
for cyanogen, three days for carbonic acid, and an unknown, but 
much longer time for hydrogen. The latter in two days and a half 
had done about one-fiftieth of the work executed by ammonia in half 
an hour. It is, however, to be observed, that the exact time for am- 
monia was not well observed, and it may have been misstated, but not 
to an extent exceeeding half an hour. 

In the attempt to discover the cause of the difference of velocity 
of the transmission of gases through porous bodies, I examined expe- 
rimentally the passage of compressed aeriform fluids through visible 
apertures. Condensed to an equal degree in the same reservoir, air, 
hydrogen, and carbonic acid were successively allowed to escape 
through an aperture distinctly visible, and the times of the descent 
of the mercury of an air-guage noted in seconds as it passed over 
equal spaces, falling from nearly four atmospheres to the usual baro- 
metric level. 

Hydrogen— 11, 10, 7, 6, 7, 5, 5, 5, 5, 4, 5, 3|, 4, 5, 6, 8, 22. 

Carbonic acid— 36, 33, 25, 24, 21, 17, 18, 16, 13, 14, 14, 12, 14, 
14, 16, 22, 29. 

Ratio on the whole, 1 to 3.163. 

Through a smaller aperture just visible the times of escape were in 
seconds. 

Hydrogen— 19, 16, 15£, 14, 14|, 12, 12|, 104, 144, 14, 17, 27. 

Carbonic acid— 51, 45, 47, 41, 36, 34, S5$, 314, 38, 37, 42s, 6l|. 

Common air— 43, 40, 40, 35, 32, 31, 31, 26, 33, 32, 38, 55. 

Ratio— 1 to 2.688—2.344. 

A repetition gave very similar results. The air escaped more ra- 
pidly than carbonic acid. 

A stucco plug a quarter of an inch in length was next used under 
like circumstances, care being taken not to compress it. The results 
were in seconds. 

Hydrogen— 74, 76, 78, 79, 80, 85, 90, 93, 98. 

Carbonic acid— 158, 155, 151, 159, 149, 174, 181, 180, 203. 

Common air— 173, 163, 169, 172, 167, 188, 200, 198, 215. 



Mitchell on the Penetration of Gases. Ill 

Ratio— 1 to 2.005 — 2.18. The air penetrates with less facility 
than carbonic acid. 

Through a compressed stucco plug rather more than an inch in 
length the times of escape were in minutes, as follows: — 

1st. Hydrogen— 12*, 11, IS*, 144, is*, 154, 18, 18*. 

2d. dq. 104, 11, 124 13f, 12$, 13*. 

1st. Carbonic acid— 17, 18|, 21*, 224, 22, 254, 29, 29|. 

2d. do. 17, 18*, 204, 20f. 

1st. Common air— 20f, 21, 234, 25, 241, 27?. 

2d. do. 194, 20. 

Ratio — 1 to 1.626 — 1.727. The air penetrates with less facility 
than carbonic acid. 

Recapitulation* 

Hydrogen. Carbonic acid. Air. 

Ratio of times — visible hole 1 - - 3.163 
Lesser aperture 1 2.688 - = 2.344 

Thin plug of stucco 1 2.005 - - 2.18 

Thick^dense plug 1 - - 1.626 1.727 

It seems, if these experiments can be trusted without frequent re- 
petition, that the larger the orifice the more nearly the proportional 
quantities of gases given out in a certain time approach to Graham's 
law of diffusion; and that the more minute the apertures the less the 
porportional facility of the escape of the lighter gas. Thus, air passes 
through a visible aperture faster than carbonic acid, but not so fast 
through the pores of stucco — while the proportional rapidity of the es- 
cape of hydrogen is greatest through the widest aperture, and though 
greater in the smallest, yet progressively lessened. It passes through 
a large opening 3.163 times as fast as carbonic acid — through a 
-smaller one 2.688 times as fast— through a thin plug 2.005 times as 
fast, and through a thick one only 1.626 times as fast. By still more 
minute channels it is possible that these two gases may pass with 
about equal facility, and pores may exist so minute as to reverse the 
order of penetration, as is demonstrated with respect to carbonic acid 
and common air in these very experiments.* The experiments to bear 
on this question are yet in progress, but those which exhibit the 
transmission through gum-elastic, wet bladder, and recent animal 
membrane, demonstrate, if not the cause, at least the fact of a reversal 
of the order of penetration; for through such in all instances the heavier 
gas penetrates much the more rapidly. If the size of orifice determine 
the penetration, philosophy may yet, by experimental investigation of 

* See page 106, where carbonic acid diffused to hydrogen by the side of a 
membrane, as 1 to 1.404. 



112 Mitchell on the Penetration of Gase3* 

the effects of apertures of visible but varied size, learn the law of B.U 
teration, and thus finally, by observing the penetration through invi' 
sible pores, calculate their size, even determine the volume of the 
penetrant atoms, and detect many mysteries of physiology and pa-« 
thology, by a process which at first seemed to promise no contribution 
to the stores of useful science. 

Other and indispensable engagements forbid my entering at present 
on a record of the many very interesting suggestions forced on us by the 
facts which have been here recorded. But they will have more weight 
when they follow the whole series, which I hope to lay soon before the 
readers of this Journal. For the imperfection of very many of my expe- 
riments 1 must be indulged, since the calls of an arduous and impera* 
tive profession often interrupted, and sometimes destroyed the most 
promising phenomena. To present them as they are, it was necessary 
to work during the night, and sometimes all night, a period not very 
favourable to nice observation and delicate manipulation. But though 
imperfectly, they are honestly made, and to avoid obscurity the 
prolix details have been stated at length, and the reader has thus the 
opportunity of judging of the correctness of both deductions and cal- 
culations. By reference to my former paper it will be perceived that 
the ratio of penetration of some of the gases as there stated is erro- 
neous, although not to an extent subversive of the great general truths 
there set forth. Cyanogen, ammonia and sulphureted hydrogen are 
less unequally penetrant than I had supposed, and the extraordinary 
alteration of rate occasioned by imbuing a dry membrane with water, 
was not then clearly enough expressed. The relation of oxygen and 
carbonic acid to each other, being that which is to the physiologist 
much the most interesting and important, has been studied in a 
greater number and variety of experiments, and so far as they are 
connected with the subject, it has been fully elucidated. For the 
rest, much remains to be done; and after I have examined in detail 
the relations of a similar kind between liquids, and the relation of 
both kinds of fluids to the blood, it is not improbable that new light 
will be shed on the dark subject of respiration. 

Enough has now been done to show that the law of diffusion through 
stucco, established so well by Mr. Graham's very philosophical labours 
and reasoning, does not apply to substances of a closer texture, and 
that physiology must depend on the experiments on animal membranes 
themselves, for the elucidation of the many important difficulties in 
the way of a satisfactory explanation of the functions connected with 
aeriform fluids. 



Mettauer's Case of Laceration of the Perineum. 113 

Art. X. Jl Case of Ununited Parturient Laceration of the Recto* 
Vaginal Septum, successfully treated with Metallic Ligatures. By 
John P. Mettauer, M. D. of Prince Edward County, Virginia. 

1 HE lady whose case forms the subject of the following communi- 
cation, was about thirty years of age when the accident occurred* 
Her health and constitution as far as I could learn, had been good 
down to the time of her confinement, which took place some time 
during the month of October* 1831. The pregnancy which resulted 
in the laceration was her first, and from its history must have been 
more fortunate than usually follows late conceptions. Her labour 
was protracted and very tedious, having continued more than three 
days, but was marked by no other important event, save the ac- 
cident. Six months after the laceration took place I was con- 
sulted, and my opinion and advice requested. The history fur- 
nished at this time, induced me to regard it a case of ununited 
laceration* and I feared that the surfaces had healed, so far at 
least, as to require denudations by art, before a reunion was likely 
to take place between them. An opinion to this effect was expressed 
to the husband of the lady, (an intelligent and highly respectable 
gentleman, of a neighbouring county;) I also informed him, that it 
was more than probable ligatures would be required before a complete 
cure could be effected. Some five or six weeks after this interview, 
the lady was conveyed to my neighbourhood, and placed under my 
immediate management; having resolved to waive all considerations 
of delicacy, (a sacrifice indeed,) if she could only obtain partial re- 
Kef from her most loathsome and health-destroying infirmity. 

In assuming the weighty responsibility of such a case, I am free 
to own, that I felt much embarrassment, the more so, as I was called 
Upon to act in a matter of great delicacy, to say nothing of its in- 
trinsic difficulties, without having had time to avail myself of the 
advice of some of my experienced brethren, or to think much upon 
the subject. The anxiety and determined purpose of my patient, did 
not permit me long to doubt and fear, and without further delay I 
was summoned to examine into the nature of the infirmity. 

The examination disclosed a complete disunion of the recto-vaginal 
wall, from the verge of the anus, three inches up the rectum, and as 
was feared, the divided surfaces had healed in every part of them. 
The cleft terminated superiorly in an angle somewhat obtuse, and 
the rectum had contracted upon itself, so as to render its several tegu- 
ments a mere band of the width of f ths of an inch. On each margin 

No. XXV.— Nov. 1833. 11 



1 14 Mettauer's Case of Laceration of the Perineum. 

of this band, a whitish line was to be perceived, commencing in the 
angle above, and continuing down to the verge. These were doubt- 
less cicatrices, and pointed out the margin of the divided rectum. 
The retaining faculty of the sphincter was completely destroyed, and 
the unfortunate lady from that cause had been compelled to submit 
to constant confinement, in a recumbent posture, to prevent the 
loathsome accident of involuntary dejections. Long-continued irri- 
tation of the wound had induced in the gastro-intestinal organs a 
morbid susceptibility which subjected the lady to frequent attacks of 
colic and diarrhoea from the slightest errors in diet. To remedy so 
afflictive an infirmity, it was necessary, not only to repair the breach 
of the rectum, but also to restore the tubular form of the rectum, and. 
contractile power of its sphincter muscle. These ends were accom- 
plished in the following manner. The patient was placed very near- 
ly as in the position for lithotomy, with the knees held apart, and ex- 
posed to the direct light of a window, the cleft was readily brought 
into view, by separating the vulvae and anterior parietes of the va- 
gina. Denudations three-fourths of an inch in width, extending 
from the angle down to the verge on each side, were now effect- 
ed along the cicatrical lines, and a little exterior to them, by the 
aid of hooks, scissors curved on their flat sides, and scalpels, 
using them according to circumstances. As soon as the wound- 
ed surfaces ceased to bleed, they were approximated, and for this 
purpose leaden ligatures were employed. These were introduced 
from within, and in succession, from the angle down to the verge, 
at the distance of one-fourth of an inch apart, care was taken to give 
them good hold; they were made to include at the same time a belt 
ofundenuded substance on each side. Needles very much curved 
were employed, with a noose of twisted and waxed silk in the eye of 
each, upon which to hang the loops of the metallic ligature, previous- 
ly formed. Dr. Physick's forceps were used for the introduction of 
the needles, which were found a very handy and convenient instru- 
ment. As the ligatures were applied they were tightened, so as to 
bring the abraded surfaces in contact, and then their ends were twist- 
ed together and cut off of convenient length. About twelve ligatures 
were required to close the breach. From time to time the ligatures 
were tightened by twisting them, and the vaginal margins of the la- 
ceration cauterized with nit. argent, to favour the formation of granu- 
lations, which it was judged would greatly strengthen the union in 
this part. The patient was confined to the recumbent posture in bed, 
with the knees tied together, to prevent as far as possible any disturb- 
ance of the wound. A diet of liquids was directed, as least likely 



Mettauer's Case of Laceration of the Perineum. 115 

to distend the lower bowels, or to elicit alvine evacuations. For four 
days the bowels reposed, and as a proof that the ligatures held the 
surfaces securely and perfectly in contact, the evacuation which now 
took place did not derange the parts or inflict much pain; and it was 
now for the first time since the accident occurred, that the propensity 
to deject could be resisted. In six weeks the ligatures were cut away, 
the parts having united perfectly. Leaden ligatures were preferred 
in the management of the foregoing case, as experience had proven 
them, not only less irritating and liable to cut out when tightly drawn 
than any other material with which I am acquainted, but infinite- 
ly more convenient and effective in maintaining a uniform and per- 
fect apposition by the ready facility of simply twisting them, and a 
proof that the leaden ligature may act forcibly for a long time without 
cutting out, when they were removed in the present instance, it 
could not be perceived that any material encroachment had been 
made upon the margins of the cleft. The lady is now perfectly res- 
tored, thirteen months since the operation was performed, as the fol- 
lowing extract from the husband's letter to me will evince: — * * * 
" and can now with pleasure and most grateful acknowledgments 
to your skill and management have it to say that she feels no incon- 
venience from the injury sustained at the time she had her child; 
and she further says that if her condition was similar to the one she 
was placed in before you operated, she would freely and willingly 
submit to it again, if she could only believe the same degree of bene- 
fit and relief were to be the result." 



( 116 ) 



REVIEWS. 

Art. XL Clinical Illustrations of the more important Diseases of Ben- 
gal, with the result of an Inquiry into their Pathology and Treat- 
ment. By William Twining, Member of the Royal College of 
Surgeons of London; First Assistant Surgeon, General Hospital, 
Calcutta. — ' Nihilque uspiam nisi quod probe exploralum habeamS — 
Sydenham. Calcutta, 1832. 8vo. pp. 705. 

X HE physicians in the service of the British East India Company 
deserve great praise for their industry and zeal in the promotion of 
medical science. Notwithstanding the active duties by which the 
greater part of their time is necessarily engrossed, they nevertheless 
find sufficient opportunities to record minutely the result of their 
clinical observations, and to present them to the public in a form well 
calculated to extend to the profession at large the benefit of their in- 
dividual experience. To these observations we are indebted, in fact, 
for the most valuable of our information in relation to the diseases of 
tropical climates. 

To a large portion of the profession in this country, the writings 
of the East India physicians have a peculiar interest; the diseases 
which prevail extensively in many portions of the United States bear- 
ing a close resemblance in their characters to those of India, and re- 
quiring for their removal an equally prompt and active treatment. 

In the work before us, published at Calcutta during the past year, 
we have a series of highly interesting observations on the more im- 
portant diseases of Bengal; namely, dysentery, affections of the liver 
and of the spleen, cholera and fevers. The author has endeavoured 
to add to our knowledge of the pathology and proper treatment of 
these by a diligent study of the phenomena attendant on their origin, 
progress and termination, with the strictest attention to the effects of 
the several remedies employed, and, in fatal cases, by a careful post 
mortem examination of the ulterior changes produced by the disease.* 
One hundred and forty-seven cases, including all the diseases just 
enumerated, are minutely detailed; and it is upon the facts derived 
from the history of these cases that the pathological and therapeutical 
deductions of Mr. Twining are chiefly founded. 

* Preface, p. v. 



Twining on the Diseases of Bengal. 117 

We have given to the work a very careful perusal, and although 
we confess this was rendered somewhat irksome by the loose style of 
the author, and the novel system of punctuation which he has adopted, 
yet we were amply compensated for our labour by the judicious re- 
marks it contains in reference to the pathological character of the 
several maladies of which it treats, and to the remedies best adapted 
for their removal. Mr. Twining is evidently a close and accurate 
observer of facts, and a bold, but at the same time extremely judi- 
cious practitioner. He is seldom led astray by the theoretical notions 
of preceding writers, however eminent, but has derived his opinions 
mainly from his own diligent investigations of the phenomena of dis- 
ease, for the prosecution of which his opportunities appear to have 
been the most ample. 

"In those instances," remarks the author, " where the treatment advised in 
this work is different from that ordered by authors on the diseases of tropical 
climates, I have proceeded with great caution, and on grounds of the most 
ample evidence, afforded by my own practice; for the support of which, I have 
relied on proofs of its utility rather than on theory, and I am happy to find 
those proofs substantiated by the testimony of my professional brethren in this 
country." 

It is true that so far as regards the observations of our author upon 
dysentery, diseases of the liver, and fevers, we have found but little 
that is really new. In relation to these affections, the pathological 
views he advances are perfectly familiar to most American physicians, 
while his plans of treatment are, generally speaking, the same as 
have been found by them to be the most successful. The work is 
not, on this account, however, the less interesting. The views of 
Mr. T. on the diseases of the spleen and on jaundice are, we confess, 
in many respects entirely novel and highly important. But we are 
persuaded that in regard to cholera, some of his opinions will not be 
found to correspond with the experience and investigations, nor will 
his practice in all its details receive the sanction of the majority of 
those physicians who have had an opportunity of studying the dis- 
ease. 

Although we cannot praise Mr. T. as an elegant or even correct 
writer, yet we feel great pleasure in giving to him full credit for the 
perfect candour with which his observations are reported, and the 
entire absence of any thing like undue pretension, which marks every 
page of his work. 

The first disease of which the author treats is Dysentery. This 
is a very common disease in Bengal, and one much more rapid and 
fatal than that which is known by the same name in Europe. It oc- 

11* 



118 Twining on the Diseases of Bengal. 

curs at all seasons of the year, but is most frequent and severe during 
the rains and at the commencement of the cold season— that is, from 
the beginning of June to the end of December. In regard to the na- 
ture of its remote and exciting causes, Mr. T. agrees with nearly 
all the late writers on the disease. 

" The most remarkable circumstances connected with the dysentery of Ben- 
gal, are the extensive local inflammation of the mucous membrane of the great 
intestines, coeval with the commencement of the disease, the early existence of 
ulceration, and in many cases a tendency to sloughing of that membrane, while 
the degree of pyrexia and other constitutional symptoms are, for the most part,, 
incommensurate with the existing local affection; the general disorder being 
apparently infinitely less than is often observed, attending a much slighter de- 
gree of local disease in other climates.'* 

Our author describes three varieties of the disease depending upon 
different stages of inflammation, ulceration or sloughing, of the mu- 
cous membrane of the large intestines. 

The first, which is the most common form of the disease in Bengal, 
differs from the ordinary dysentery of this country only in the greater 
violence of its symptoms and its more rapid progress. In severe 
cases of only a few days duration, masses of sloughing membrane are 
occasionally voided. 

The second variety comes on suddenly; the most violent symptoms 
occurring within the first thirty-six hours and unpreceded by any evi- 
dent disease. Pure blood is poured out from the bowels at an early 
period, attended with little distress, excepting the disturbance from 
frequent calls to stool. In three or four days the stools have a horrid 
odour of putrid blood — this with a weak, rapid pulse, and hiccup, are 
almost always signs of a fatal termination. There is often little or 
no fever, the tongue is comparatively clean, the pulse frequently soft, 
the skin cool and perspiring freely, and pressure on the abdomen 
gives little uneasiness until we examine with care over the ccecum, 
when pain is almost always excited. These cases the author has 
found often to depend on numerous distinct circular ulcers in the 
colon, with elevated, thick, and abrupt edges, which are in a slough- 
ing state, while the muscular fibres of the intestine appear at the bot- 
tom of the ulcer as if dissected clean. 

The third variety is marked by an incessant desire to evacuate the 
intestines from the very onset of the disease, attended with urgent 
straining while at stool; the discharges consisting only of a little 
bloody mucus without any appearance of feces. The pulse is rapid 
and often small and hard. An uneasy sensation above the pubis,, 
pain in the bladder and suppression of urine, frequently attend the 



Twining on the Diseases of Bengal. 119 

worst cases, in consequence of the inflammation extending to the 
lower portion of the intestine contiguous with the fundus of the blad- 
der. Anxiety and restlessness increase early, and the latter stages 
of the disease are attended with more fever than is common in the 
preceding cases. The patient generally dies miserably emaciated 
between the eighth and twelfth days. Towards the close of protracted 
cases, the tongue becomes often covered with a brown mucus, or is 
dry, and the teeth are loaded with sordesj delirium and low fever ex- 
isting at the same time. 

The following are enumerated as the ordinary appearances detected 
upon dissection, in the bodies of those who die of dysentery. 

Inflammation, ulceration, sloughing or mortification of the inner 
coats of the large intestines. 

Morbid vascularity of the mesocolon, mesentery and omentum. 
Adhesions of the omentum to the adjacent parts, and of contiguous 
portions of the intestines to each other. The latter usually happen 
only when ulcers of the intestines have perforated through nearly all 
the coats. 

The glands of the mesocolon and mesentery often enlarged, some- 
times inflamed, and more rarely suppurating; the corresponding por- 
tion of the intestines usually containing a deep and large ulcer. The 
omentum occasionally adheres to these diseased glands, forming a 
band that may strangulate a portion of intestine and cause death. 

The ulcerations of the great intestines are generally most numerous 
and extensive in the coecum and upper portion of the colon. The 
ileo-coecal valve has in some cases been found entirely destroyed by 
ulceration, the lower end of the ilium forming an intussusception into 
the coecum, and becoming there strangulated has caused death. In 
a few more fortunate instances the strangulated portion of the ilium 
sloughs off, after adhesion has taken place between the adjacent parts, 
so as to maintain the continuity of the canal, and the patient slowly 
recovers. 

The right portion of the omentum is frequently found adhering to 
the coecum, and this morbid attachment gives rise to symptoms which 
may be mistaken for hepatic abscess. 

In a few instances the coats of the colon are so much thickened, 
that when a transverse section is made, its canal stands open like a 
thick leathern tube, the interior of the intestine being covered with 
numerous large ragged ulcers, in the intervals of which the mucous 
membrane is partly destroyed and hanging in shreds. 

"In several of thes^ cases," remarks Mr. T. "I have observed the coecuni 
and lower portion of the ascending" colon, nearly covered with a thick layer 



120 Twining on the Diseases of Bengal. 

of coagulable lymph, deposited beneath the peritoneal coat of the intestine, and 
beneath the gut, extending a considerable distance along the iliacus muscle; 
in some instances, an unusual quantity of fat has been found at the same part, 
mixed with this inflammatory exudation. In other cases, when the disease has 
been more protracted, the whole of the great intestines are contracted in di- 
ameter, resembling a cord, and numerous small superficial ulcers are observed 
on their interior. In several of these cases, the internal surface of the coecum, 
and four or five inches of the colon, are of a fleshy appearance, and of a livid 
red colour, inclining to brown, as if from a growth of granulations. I have met 
with but few cases of this sort, and when this condition of the coecum has exist- 
ed, a smaller space of the sigmoid flexure of the colon has exhibited a similar 
appearance. The patients have been much emaciated, with flat retracted 
belly and dry skin, the tongue of a slate colour, glossy and morbidly clean, as 
if skinned; the stools an opaque dirty-brown water." 

Sometimes in the whole course of the colon we find not more than 
eight or ten large deep ulcerations, with sloughing, thick, abrupt, 
raised edges, surrounded by an extensive thickened base, into which 
sinuses and undermining cavities are seen to penetrate. These ap- 
pearances have reminded our author of the foul ulceration at the 
centre of a small carbuncle. He has seen several patients die with 
not more than six or eight of these spots of disease in the colon. 
They had flushed face, restlessness and continued symptoms of fever, 
which were not easily subdued by remedies. 

The last three or four inches of the ilium are generally affected 
with superficial ulcerations and roughness. With this exception we 
rarely find any disease of the small intestines in the bodies of those 
who die of dysentery. In those cases, however, where dysenteric 
symptoms occur towards the termination of protracted fevers, after 
death ulceration of the small intestines frequently exists, and may 
be deemed one cause of the tardy and imperfect convalescence from 
fever. 

When the patient has died after protracted suffering from dysen- 
tery, we often find the cellular structure at the root of the mesentery 
and mesocolon, and across the bodies of the lower lumbar vertebrae, 
deprived of its usual elasticity and pliability, and to a certain degree 
indurated ; and in many cases quite void of fat. This change Mr. 
T. conceives to be the result of a previous inflammatory condition of 
the parts — an interstitial exudation of coagulable lymph having taken 
place in the course of the disease. 

Mr. T. cannot agree with those physicians who consider dysentery 
as very generally dependent, especially in tropical climates, on an 
affection of the liver, or a vitiated condition of the biliary secretion. 

"If," he remarks, u dysentery be ascribable to a disordered state of the 



Twining on the Diseases of Bengal. 121 

bile, I would ask, how does it happen that the great intestines are the parts 
principally diseased in dysentery? while the small intestines are very seldom 
affected, although the bile has to pass along the course of the small intes- 
tines before reaching the coecum and colon? I would also ask, if the black 
and discoloured stools depend on disordered bile, how it happens that the con- 
tents of the small intestines are almost always of different shades of yellow or 
orange colour; while in these same subjects we almost always find the feces 
immediately on passing into the great intestine, become of a dark gray, dark 
brown, or black colour? There must be something besides bile to produce this. 
I would further ask, what evidence have we that the dark colour of the fecal 
evacuations, is always dependent on the presence of disordered bile ? Until 
some proof is afforded on this point, we may reasonably hesitate to ascribe 
the occurrence of dark-coloured or black stools, in this climate, invariably 
to disordered secretions from the liver: we should be less apt to speak con- 
stantly of the black cystic bile, when the evacuations are of a very dark co- 
lour, and we should be less inclined to suppose, that calomel is indispensable 
in all these cases." 

We fully concur with our author in the belief that if a series of 
careful observations were undertaken in relation to the several que- 
ries contained in the preceding paragraph, we should be led to very 
different views to those which are now generally entertained in rela- 
tion to the dark-coloured tenaceous discharges so frequently observed 
in the course of those diseases in which the alimentary canal is prin- 
cipally affected. We believe that in numerous instances it will be 
found that they are entirely unconnected with a vitiated state of the 
biliary secretion, and that the common plan of administering calomel 
in all cases in which they occur, is, to say the least of it, injudicious. 

It is admitted by Mr. T. that dysentery and hepatic disease do oc- 
casionally coexist. The advanced stages of abscess of the liver he 
has found almost invariably accompanied by dysentery. The usual 
causes of dysentery^ sudden alternations of temperature combined 
with a humid atmosphere, may, also, at the same time that they give 
rise to an inflammation of the intestines, produce in certain indivi- 
duals, hepatic congestion and irritations while in other cases the in- 
flammation of the bowels may be transmitted to the liver. , 

In these latter cases symptoms of hepatic disease are not evident, 
until the dysentery has existed many days, frequently not until the 
latter is decidedly on the decline' — even after there has been an ap- 
parent convalescence for a day or two. 

" At a very early stage of these affections," Mr. T. observes, " when the he-* 
patic disease is seated in the right lobe; the right rectus abdominis muscle* 
is more tense than the left, and it resists pressure by an involuntary resiliency." 

This morbid tension of the right rectus abdominis, it may be re-, 
marked, the author considers to be in all cases one of the early 



122 Twining on the Diseases of Bengal, 

symptoms attending that form of hepatic disease which is liable to 
terminate in central abscess of the right lobe of the liver. 

Mr. T. is of opinion that the affection of the liver occurring to- 
wards the terminating of dysentery arises from the abrupt cessa- 
tion of the copious secretions from the mucous membrane of the 
intestines, while some degree of the inflammatory condition of the 
membrane is unsubdued; the decrease in the discharge from the 
bowels giving rise " to relative plethora of the mesenteric vessels, 
and consequent hepatic congestion and irritation." That the irri- 
tation in these cases is transmitted from the intestines to the liver, 
we may admit — and probably it is very frequently caused by neglect 
or improper management after the more violent symptoms of the 
bowel affection have been removed. The explanation of our author, 
however, appears to us to be altogether untenable. 

In the treatment of the acute dysentery of Bengal, the earliest at- 
tention and most constant care of the physicians, Mr. T. remarks, 
must be directed to subdue the local inflammation upon which the 
disease depends. He urges, therefore, the prompt, free and repeated 
use of the lancet, with the application at the same time of leeches 
over that part of the abdomen where pressure causes the most pain. 
In the majority of cases it will be proper, we are told, to continue 
this system of active depletion, so long as fever exists, or pressure 
on the abdomen gives pain, or there is any blood in the stools. 

About two hours after the first leeches are removed a tepid bath 
is directed, which is to be repeated daily during the continuance of 
the disease. Many cases, the author remarks, if treated at the com- 
mencement by these remedies, will be readily cured by them alone. 

"When we consider that the disease depends upon an acute inflam- 
mation of the mucous membrane of the great intestines proceeding on, 
more or less rapidly, to ulceration or to gangrene, there can be little 
doubt as to the propriety of the above remedies. We know from ex- 
perience, that upon their early and judicious use, in all severe cases, 
the safety of the patient will mainly depend. Even in the mildest 
cases, the application of leeches to the abdomen can rarely, with pro- 
priety, be dispensed with. 

Immediately after the first bleeding, Mr. T. administers a dose of 
castor oil, and when it has operated freely, a combination of six 
grains of ipecacuanha, four of extract of gentian, and five of the blue 
mass, in three pills, which dose is repeated every night and morning; 
while in the middle of the forenoon he directs daily forty grains of 
cream of tartar with twenty of jalap. The latter prescription he su pposes 
to act principally on the small intestines, and by the copious fluid eva- 



Twining on the Diseases of Bengal 123 

cuations which it induces to remove the congestion of the mesenteric 
vessels, diverting, in this manner, the morbid vascular turgescence 
from the colon and mesocolon. It also effectually evacuates the 
great intestines. Its remote effects he conceives to depend partly on 
its diuretic properties, and partly on its increasing the activity of the 
absorbents and enabling them to remove the interstitial deposit usually 
attendant upon severe acute inflammation. 

After a few days, Mr. T. sometimes omits the compound powder 
of jalap, and directs early in the morning a drachm of sulphur mixed 
with half an ounce of mucilage and one of cinnamon water. He is 
of opinion that in chronic cases, the sulphur promotes the healing of 
the ulcers in the intestines by its actual contact with them. Not 
only in the acute stages of dysentery is this active purgation recom- 
mended by the author, but subsequently, he directs every second 
night, at bed-time, six grains of the blue mass, with the same quan- 
tity of compound extract of colocynth, to be followed in the morning 
by one ounce of infusion of senna, the same quantity of infusion of 
quassia, and two drachms of Epsom salts. These remedies he con- 
tinues for a fortnight after convalescence is established, and this with 
the view of removing the interstitial deposit of coagulable lymph or of 
serous fluids produced by the inflammation, especially in cases that 
have gone on to ulceration. 

We confess that we cannot understand the rationale of this pro- 
fuse administration of purgatives in the treatment of dysentery. 
Urging an inflamed bowel to increased activity appears to us to be 
rather a strange mode of removing the inflammation, while we can- 
not perceive a single indication to fulfil which the employment of 
purgatives is demanded. We are aware that they are recommended 
by the most eminent writers upon the disease, some of whom even 
advise its cure to be trusted to them alone. That they increase, how- 
ever, in most cases the irritation of the bowels, and augment consi- 
derably the sufferings of the patient, we know from experience; in 
consequence, we have for many years almost entirely omitted their 
use, and have found much reason to be pleased with this change of 
treatment. In cases where ulceration of the intestines is suspected to 
exist, we hold purgatives to be altogether inadmissible. Mr. T. ad- 
mits, that in all the stages of dysentery great caution is demanded 
in the administration of saline purgatives, the mildest of them being 
apt to irritate by carrying off the natural mucus of the intestines. We 
maintain that more or less irritation will be produced by the action 
of all purgatives. 

The author is opposed to the use of large doses of calomel in the 



124 Twining on the Diseases of Bengal 

treatment of dysentery. He seldom employs it even in small doses, 
and never to the extent of producing salivation. It will be easy to 
show, he remarks, that calomel is often not only useless, but that in 
many cases of the dysentery of Bengal, it is exceedingly injurious. 
This opinion is founded upon his own experience, having tried the 
medicine extensively in every form of the disease. There is one 
form of dysentery, however, in which, after active depletion by the 
lancet, he has several times seen the most remarkable and immediate 
good effects from scruple doses of calomel and ipecacuanha combined, 
followed at the end of four hours by a drachm of the compound powder 
of jalap. This occurs in robust subjects, with considerable pyrexia 
when the patient has not been more than three or four days ill. It 
is attended with frequent calls to stool, all that is voided each time 
being only about half an ounce of reddish mucus* 

Of the efficacy of ipecacuanha in the dysentery of Bengal, Mr. T. 
speaks in the highest terms. In cases occurring in children he states 
it to be unequalled by any remedy he has tried. The extract of gen* 
tian prevents the action of the ipecacuanha upon the stomach without 
impairing its curative properties. In the preface to the work the tes- 
timony of several other practitioners of India is adduced in proof of 
the beneficial operation of the remedy in this disease. The author 
might have extended his references to nearly all the authoritative 
writers on dysentery. By most of them the good effects of the ipe- 
cacuanha are pointed out in the strongest terms. In combination 
with the blue mass and minute doses of opium, we are ourselves in 
the constant habit of employing it, and always we are persuaded with 
decided advantage. 

To remove the painful affection of the bladder, and suppression of 
urine that attend bad cases of dysentery, the author has found in* 
jections of cold water into the rectum to have the most prompt and 
certain effect. They will also, he states, be found an excellent 
remedy for the copious discharges of blood which frequently occur. 
In like cases a solution often grains of acetate of lead in ten ounces 
of water will often be beneficial. 

Blisters Mr. T. recommends only after the more acute symptoms 
of the disease have been reduced by bleeding; a small blister near 
any local induration that may exist, is then often serviceable, espe- 
cially if kept open for a week or ten days. 

The administration of opium by the mouth in dysentery, Mr. T. 
entirely condemns. He has very often found it injurious by masking, 
as he terms it, the most deadly symptoms until the patient was past 
recovery. In cases, however, in which tenesmus is severe at night* 



Twining on the Diseases of Bengal. \26 

he has found an injection of sixty drops of laudanum in two ounces 
of cold water to remain in the rectum all night, and to promote great- 
ly the comfort of the patient. In the use of opiates in dysentery, 
great caution is undoubtedly to be exercised. Until the violence of 
the inflammation is reduced by active depletion, they are, in general, 
inadmissible^ but, after this has been effected, opium combined with 
ipecacuanha and the blue mass may be safely administered, and we 
have* generally found its use to diminish the tormina and tenesmus, 
and in this manner procure great relief to the patient. Injecting 
opium into the rectum is certainly one of the most efficacious means 
we possess for relieving the distressing tenesmus which so frequently 
attends the disease. As an injection we prefer the solid opium rub- 
bed up with olive oil, flaxseed tea or thin starch, to the laudanum as 
recommended by our author. 

" Tenesmus," remarks Mr. T. " is usually dependent on ulceration low down 
in the rectum; and may frequently be relieved by using an ointment composed 
of thirty grains of sugar of lead, mixed in one ounce and a half of fresh lard, of 
which a portion, half the size of a nutmeg, may be introduced into the rectum 
three times a day." 

When tenesmus remains after the more prominent symptoms of 
the disease have been removed, an injection of one drachm of acetate 
of lead dissolved in eight ounces of tepid water was a favourite pre- 
scription with Mosely, and we are persuaded will in many cases be 
found to afford prompt relief. 

No notice whatever is taken by the author of the administration of 
the acetate of lead by the mouth in the treatment of dysentery. We 
have ourselves employed it pretty extensively subsequently to active 
depletion by the lancet or leeches, in combination with ipecacuanha 
and opium, and in most cases have found it to produce the most be- 
neficial effects. 

The remarks of Mr. T. on the great importance of caution in re- 
gard to the nature and amount of the drink and food allowed to the 
patient during the disease, as well as in the stage of convalescence, 
are in the highest degree judicious. It is all important to keep the 
colon as nearly as possible empty while the least degree of inflam- 
mation exists, and during the healing of the ulcers which may have 
been formed in the intestines. While the disease continues, the 
mildest diluents only should be allowed, and for some time after its 
removal the patient should be restricted to bland unirritating food 
taken in very moderate quantity. " Errors in diet are the principal 
cause of tardy recovery and frequent relapses." 

When we perceive how fully the author is impressed with the im- 

No. XXV.— Nov. 1833. 12 



126 Twining on the Diseases of Bengal. 

portance of guarding the inflamed bowels in cases of dysentery from 
every source of irritation — even that which may be caused by too 
large an amount of the blandest drinks, we feel the more surprised 
that he should be willing to subject them to the daily irritation of ac- 
tive purgatives. 

Dysentery very often occurs in patients affected with what is 
termed land scurvy, which differs from the porphyra hemorrhagica 
of Good, only in being less frequently accompanied by profuse dis- 
charges of blood from slight causes. In these cases the administra- 
tion of mercury very generally proves exceedingly injurious. Their 
treatment may be trusted, according to our author, to the adminis- 
tration of the compound powder of jalap, in such doses as shall effec- 
tually carry off the vitiated secretions without irritating, together 
with the ipecacuanha combined with extract of gentian; while a more 
restorative diet is allowed than would be consistent in uncomplicated 
cases. Still excess of food must be guarded against. 

Mr. T. describes at page 63, a form of dysentery in which the inflam- 
mation is chiefly confined to the rectum and lower portion of the co- 
lon: but as these cases require no essential modification of the treat- 
ment already noticed, we shall pass over the observations of the au- 
thor in regard to them. 

In describing the post mortem appearances in fatal cases of dysen- 
tery, we noticed various morbid conditions of the ccecum as of occa- 
sional occurrence; at page 69 Mr. T. directs the particular attention 
of his readers to these affections. Their neglect leads to almost cer- 
tain destruction of those patients in whom they occur. No particu- 
lar change in the general treatment of the case, however, is demand- 
ed. All that is necessary is for the practitioner to bear in mind the 
possibility of the occurrence of more or less violent inflammation of 
the coecurn, and by the most undeviating perseverance in the employ- 
ment of the remedies demanded for its removal, especially the local 
application of leeches, to prevent the disorganization of the intestine 
and the death of the patient. 

" When," remarks Mr. T. " a considerable enlargement of the coecum takes 
place during dysentery, it is usually first noticed about ten or fourteen days af- 
ter the commencement of the disease. The disease is not usually attended with 
so much pain as to make the patient complain particularly of the part affected, 
and unless the practitioner habitually examine the abdomen of those he is treat- 
ing for dysentery, he will be occasionally told of the swelling, at a period of 
this disease when the patient is past recovery: or he will find, on dissection, 
such a mass of disease and inflammation, with induration in the right iliac re- 
gion, that he will be surprised how it could have escaped his notice during life* 
Except in fat persons, the rounded, doughy, inelastic tumefaction of the coecum 



Twining on the Diseases of Bengal. 127 

is easily detected by examination with the hand; and, in fact, is often visible on 
inspection." 

"It requires to be treated, by the daily repetition of leeches to the part; fo- 
menting, and applying hot poultices to the leech-bites while they are bleed- 
ing. After the morbid sensibility of the part is removed, and the tumefaction 
much reduced, it is requisite to disperse the remaining induration, by a blister 
kept open over the part, and by just such a course of Plummer's pill, and ex- 
tract of colocynth, at night, followed by the compound powder of jalap, in the 
morning, as would be suitable to remove induration that had immediately fol- 
lowed an inflammatory swelling on the arm, or thigh, or any other part of the 
body; only, here we must remember, that no part of the disease can be left un- 
subdued, without hazard to the patient's life." 

In cases where intussusception of the ileum into the coecum oc- 
curs, the most active antiphlogistic measures are requisite until in- 
flammation is subdued; after which entire quiescence in the recum- 
bent posture must be observed. 

When in cases of dysentery sloughing of the mucous coat of the 
intestines take place, the patient is very generally destroyed. In 
such cases, however, the author has occasionally seen good effects to 
result from the administration of quinine with small doses of opium. 

In chronic dysentery the patients are much debilitated and distress- 
ed by frequent watery purging; the faeces are mostly of a pale-gray 
colour, mixed with mucous and more or less white matter. A por- 
tion of the food is often discharged undigested, the evacuations being 
of various hues. The stools sometimes consist of a copious paste- 
like brown mass, in a state of fermentation. Occasionally they are 
frothy, with a whitish or pale-gray sediment like a mixture of chalk 
and beer. In a few very protracted cases the stools are very copious, 
quite watery, and vary from bright orange to a pale straw colour. 
Blood is rarely present in the discharges, and the patients do not suffer 
from fever excepting in those cases in which there is extensive irrita- 
tion of the mesenteric glands; and then, occasionally, hectic fever is 
observed. The abdomen is generally flat, inelastic, and somewhat 
retracted; in a few cases, however, tympanitis is a troublesome symp- 
tom. The skin is often arid, shrivelled, and desquamating. 

"The objects," remarks Mr. T. "to be held in view in the treatment of chro- 
nic dysentery, are to remove the local morbid affections and restore the pa- 
tient's strength. For these purposes, our remedies must be directed to procure 
a regular and uniform secretion from the mucous membrane of the intestines, 
by the influence of mild purgatives; and by such remedies as have the pro- 
perty of restoring capillary circulation to a healthy state, and moderating pro- 
fuse discharges; for this latter purpose, frequent small doses of ipecacuanha 
answer very well." "Leeches are frequently of much service; and when- 



128 Twining on the Diseases of Bengal. 

ever indurations can be felt, unattended by morbid sensibility on pressure, or 
by any pyrexia, blisters are generally very important remedies." 

In cases attended with any degree of morbid heat, Mr. T. directs 
a mild purgative of compound powder of jalap, but in those with a 
dry, shrivelled, and cold skin, he prefers a drachm of sulphur mixed 
with mucilage and cinnamon water. After the purgative, the pa- 
tient is to take ipecacuanha, extract of gentian, and blue mass, of 
each four grains, to be repeated every night, and at noon, daily, a 
wine-glassful of the following mixture. R. Infus. ipecacuanha, ^j.; 
Infus. gentian, compos., Misturaecamphorse, aa. §v.; Tinct. cardamon. 
comp., 5U« M. The infusion of ipecacuanha is made from 9j. ipe- 
cacuanha to ^j. of boiling water. During the whole treatment, the 
patient is to be confined to a mild, unirritating diet in very moderate 
quantity. 

We have nothing particular to object to the above treatment, 
with the exception of the daily administration of purgatives, from 
which we are persuaded no good can result, while it is certainly cal- 
culated to add to the irritation under which the intestines are labour- 
ing, and to prevent the healing of ulcerations. In the treatment of 
chronic dysentery we have seen the best results from the judicious 
employment of leeches, the internal administration of the ipecacuanha 
and blue mass, in conjunction with the daily use of the warm bath, 
or fomentations to the abdomen assiduously employed, and a properly 
regulated but restricted diet. Attention to diet, in many cases, is 
of equal, if not of more importance than the exhibition of remedies. 

The views of our author in relation to the pathology and treatment 
of dysentery are illustrated by the history of thirty-one cases. 

The consideration of the diseases of the liver forms the subject 
of the second chapter. It will be impossible for us to notice the 
highly interesting observations of our author in regard to these dis- 
eases so much in detail as we have those on the disease which pre- 
cedes. We have only room for a brief sketch of the more important 
of his remarks. 

After noticing the fact that many practitioners are too much in the ha- 
bit of ascribing every obscure chronic affection to some functional disor- 
der of the liver, and by the injudicious use of mercury increasing the 
disease under which the patient actually labours, when probably the 
liver is entirely unaffected, Mr. T. enumerates the various morbid 
appearances he has detected in those who have died in Bengal after 
suffering from hepatic disease, and then details the symptoms of acute 
hepatitis. 



Twining on the Diseases of Bengal. 129 

In many cases, he remarks, inflammation of the liver is often far 
advanced towards suppuration without the patient having suffered 
much pain. By a careful examination, however, Mr. T. has always 
been enabled to detect the disease of the liver long before there was 
any reason to believe that suppuration existed. 

"The best mode of examination, is to place the patient on his back on a 
couch, the head not being" raised, and then to stand at the foot of the bed, so 
that we can see if the right side be enlarged, the cartilages of the ribs heaved 
up, or if there be more fulness at the right side of the epigastre than at the 
left. We ascertain the existence of pain, or induration, by careful pressure 
over the right hypochondre, while the right false ribs and side are raised by 
one hand, so as to carry the liver forwards. Having examined the state of both 
hypochondria, and the epigastre, during a full inspiration, as well as during a 
full expiration, and when the right thigh is bent, as well as when it is extended; 
we afterwards turn the person gradually over towards the left side, so as to be 
lying almost on his face, and then press carefully over the region of the liver, 
desiring the patient at the same time to make a full respiration." 

According to our author the most prevalent form of acute liver dis- 
ease in Bengal is an inflammatory congestion with tendency to cen- 
tral abscess of the right lobe of the liver. A very common and early 
symptom of this affection he has found to be a much greater de- 
gree of tension of the right rectus abdominis muscle, than of the left; 
the muscle on the right side resisting pressure by a quick involun- 
tary action, while the left muscle is lax, and the other parts of the 
abdomen soft and elastic. He has seen the left muscle affected 
in the same way in patients who have afterwards died with abscess 
in the left lobe only. After protracted cases of this form of he- 
patic disease, especially when they occur at the latter end of the 
rains and beginning of the cold season, Mr. T. has observed on dis- 
section, in the cellular structure of the mediastinum some degree of 
interstitial deposite of an albuminous appearance. The cellular struc- 
ture at the root of the mesentery and mesocolon, particularly across 
the upper lumbar vertebrae is, also, often in a state of vascular en- 
gorgement, with more or less of serous infiltration. Oppression at 
the chest and tension of the belly are frequently produced and kept 
up by these morbid conditions, as well as by the turgescence of the 
liver. 

The author describes another form of liver complaint, distinct from 
the preceding, as common in Bengal at all seasons of the year. It 
sometimes follows fevers, but generally occurs without any very ap- 
parent cause. 

•■ The patients complain of pain at a circumscribed space about four inches 
above and to the right of the navel, on a line drawn from the umbilicus to the 

12* 



130 Twining on the Diseases of Bengal. 

point of the right shoulder? and the disease is attended by the following cir- 
cumstances. The attack sometimes commences suddenly after eating, and in 
that case the food is usually vomited, whereby a transient relief is experienced; 
the respite is but short, for the pain soon returns, and pressure over the part 
cannot be borne; a full inspiration increases the pain, and the patient is un- 
able to stand erect, or to lay straight in bed; he rests with the body bent 
forward, and inclining to the right side; there is great anxiety, and the nights 
are passed without sleep; there is usually a sense of weariness and pain in 
the loins: tumefaction of the liver is seldom evident. In severe cases the 
pain shoots back towards the lower angle of the scapula or up towards 
the shoulder, and is of the acute kind that is usually spoken of as a stitch or 
spasm, which prevents coughing or sighing. The bowels are usually costive 
at first, the urine high-coloured, and jaundice sometimes takes place. There 
is a dry tongue, thirst, head-ache, and a frequent pulse, but not generally very 
high fever corresponding with the acute pain. In the latter stages of the dis- 
ease, a distressing purging of black watery fluid takes place, and sometimes 
much blood is passed by stool. Severe cases, if not arrested by a very decisive 
and persevering treatment, will run their course in twenty or twenty-five days. 
During the last six or eight days, the profuse discharge from the bowels usually 
attracts most attention, and the patient dies from irritative fever, produced by 
inflammation and congestion, which affect not only the liver, but the capsule of 
Glisson; and in some measure extend to the cellular structure round the duo- 
denum, and at the root of the mesentery. It is not common for abscess of the 
liver to form, after the course of disease above described, though that is some- 
times the case. 

A less acute affection of the same parts is very frequently met 
with, the pain is less severe and does not extend to the scapula 
and shoulder, nor is it very distressing even upon pressure. Occa- 
sionally there is slight fever, and most generally the tongue is moist, 
yellowish, and loaded; in protracted cases it becomes sometimes 
clean. The urine is often high-coloured for several days and then 
resumes its natural appearance. There is occasional nausea with 
impaired appetite, a sallow, haggard, and lurid countenance, the 
limbs become slowly emaciated, the abdomen is tense and sometimes 
tumid. The bowels are usually irregular, the evacuations being 
scanty, black, and costive for a day or two, and then fluid and unsa- 
tisfactory; sometimes nearly white, at others tinged with blood. Mr. 
T. has seen cases of this kind continue for eight or ten months; the 
patients having been repeatedly salivated and blistered. The disease 
is liable to change into the acute form and terminate in abscess of 
the liver; in emaciated subjects, however, it more commonly causes 
jaundice or dropsy. 

Mr. T. is of opinion that the stimulant and opium treatment of de- 
lirium tremens often lays the foundation of abscess of the liver, or in 
other words, that hepatic abscess would less frequently succeed to 



Twining on the Diseases of Bengal, 131 

delirium tremens were the febrile and inflammatory symptoms, with 
which the latter is so often accompanied, treated by antiphlogistic 
remedies. 

"The following diseases," according to our author, "are liable to be mis- 
taken for affections of the liver, viz. empyema, or hydrothorax of the right side 
of the chest; disease of the right lung; ulcers and some chronic disorders of 
the stomach; disease of the duodenum, or of the ccecum, and a loaded state of 
those intestines without actual disease; ascirrhus pylorus; indurated pancreas; 
induration of the transverse colon in severe dysentery, with a solitary large 
sloughing ulcer and thickening of the coats at that part of the intestine; adhe- 
sion of the omentum majus to the coecum, or to the brim of the pelvis." 

In two cases Mr. T. has known an affection of the spine, attended 
with pain of the right side, to be mistaken for diseased liver and 
treated with mercury to the manifest injury of the patients. 

In the treatment of acute cases of hepatic disease, the o,bject, ac- 
cording to our author, is to diminish considerably the amount of the 
circulating fluids, and permanently to subdue the action of the heart 
and arteries by active depletion; while by the use of purgatives, ab- 
stinence from food and allowing very little drink, to keep the system 
so empty and low that absorption shall be performed with activity. 
This condition is to be maintained by a steady perseverance in pur- 
gatives and repeated direct depletion, until the removal of the vascu- 
lar turgescence is effected as well as the complete absorption of the 
interstitial deposite, of which more or less exists in almost all acute 
inflammations of the liver, very soon after the disease commences. 

"In all severe acute cases of hepatitis," he remarks, "the patients life de- 
pends on a systematic pursuance of general and local blood-letting, with quies- 
cence and strict attention to almost entire exclusion of food; even drink should 
be taken in limited quantity, while we are endeavouring to empty the vascular 
system." 

Mr. T. advises the bleeding from the arm to be performed while the 
patient is in a recumbent posture to avoid the occurrence of syncope. 

If tumefaction of the liver remains after the fever is removed, and 
the patient's strength is much reduced, he directs a blister, three 
inches square, to the epigastrium, which is to be kept running; at the 
same time from four to six leeches are to be applied around the edge 
of the blister daily, "so as to maintain such a drain from the ca- 
pillary vessels, as that the strength may admit of its continuance 
for several days." After this, half a drachm of camphorated mer- 
curial ointment is to be well rubbed over the side once a day and 
a moderate purgation kept up. 

Our author very properly objects to the application of a blister un- 



132 Twining on the Diseases of Bengal. 

til the symptoms of general excitement as well as the severity of the 
local disease have been subdued. He warns his readers, also, against 
a too speedy cessation of active treatment. In almost all acute cases 
of hepatitis the urgent symptoms are mitigated long before the local 
disease is entirely subdued; if under these circumstances the practi- 
tioner be lulled into security and cease the exhibition of proper re- 
medies, or neglect to confine his patient to a strict diet, a more in- 
tractable disease becomes established and eventuates in death. 

The acute superficial inflammation of the liver and the inflamma- 
tory congestion with tendency to central abscess, as well as the in- 
flammatory condition more especially affecting the capsule of Glisson 
with much hepatic congestion, require nearly the same treatment. In 
the milder cases of the last mentioned affection the daily repetition 
of leeches with mild purgatives and a well-regulated slender diet 
must be persisted in for a long period. 

We pass over the section devoted to abscess of the liver with the 
exception of the two following paragraphs with which the section 
closes. These point out the causes which according to the author's 
experience give rise to very serious relapses of hepatic disease. 

"Where a system of very active treatment for acute cases, is suddenly re- 
mitted after two or three days, and, at the same time, a premature return to a 
full diet gives rise to vascular repletion and increased action of the heart and 
arteries; causing serous interstitial deposite and central abscess of the liver. 

" When bleeding has been either omitted, or inefficiently used at the com- 
mencement of acute inflammation of the liver, and the cure trusted to leeches 
and mercury, at the same time that low diet and tranquillity in the recumbent 
posture have not been strictly attended to, the disease, attended with obscure 
symptoms, is prolonged for several weeks, after which, an extensive abscess of 
the liver is almost inevitable." 

In the ensuing section the chronic diseases of the liver are consi- 
dered. Many of the cases usually denominated chronic, the author 
is persuaded differ rather in degree than in any thing essential from 
the acute disease; and require a continued perseverance in the use 
of the same remedies; although the same activity of treatment is not 
demanded as in the latter. 

" In fact," he adds, "our distinct views of liver disease and satisfactory modes 
of cure refer almost entirely to the acute forms; and as we lose sight of these, 
the management of the disease becomes vague and unsatisfactory." 

Under the head of Jaundice we meet with several very interest- 
ing and important observations. The author has found jaundice, not 
only during its early stage, but for a long period afterwards, while 
the discoloration of the skin remains, to be very generally attended 



Twining on the Diseases of Bengal. 133 

with some morbid sensibility when pressure is made over the situa- 
tion of the gall-bladder and capsule of Glisson, though the uneasi- 
ness, during the absence of pressure, is most generally referred to 
the epigastrium. 

When the disease occurs in plethoric subjects, and the stools are 
of a pale clay colour, the author has found it almost always attended 
with fever, and in some cases he has known robust patients die with 
symptoms of oppressed brain, within thirty-six hours after the sudden 
appearance of intense jaundice, for the accession of which no cause 
could be assigned. 

In consequence of the acknowledged obscurity which exists in regard 
to the true pathology of this disease, Mr. T. was anxious to ascertain 
the exact condition of the liver and biliary ducts in*persons labouring 
under jaundice. The almost invariable existence of pain increased 
upon pressure, confined to a circumscribed spot on the right side, 
just below the centre of a line drawn from the right nipple to the 
umbilicus, led him early to suspect limited inflammation of some part 
of the liver to be the most frequent cause of the disease. This opinion 
was, he believed, confirmed by the good effects which, in the majo- 
rity of cases, follow a systematic course of depletion: nevertheless, 
if circumscribed inflammation were the efficient cause of the disease, 
he was unable to explain why jaundice was so frequently absent du- 
ring the progress of the most unequivocal and intense inflammations 
of large portions of that organ. On the dissection of subjects who 
had recovered from jaundice, only a short time before death occurred 
from other diseases, he could not discover any appearances in the 
liver by which he could fix upon any circumscribed spot as having 
probably been recently inflamed. But in the course of his dissec- 
tions he found that albuminous infiltration sometimes takes place into 
the cellular structure of the capsule of Glisson. Within this capsule 
are situated two small bodies which, from their structure, appearance, 
and uniformity of situation, Mr. T. is inclined to believe are absorb- 
ent glands. One of these is situated near the termination of the gall- 
bladder in the cystic duct; the other at the upper part of the ductus 
communis choledochus. The superior gland is sometimes very small 
and occasionally it is more closely attached to the side of the gall- 
bladder than to the cystic duct. The lower one is more uniform in 
bulk, being usually half the size of a small bean, and it is always 
placed just at the commencement of the common biliary duct. The 
result of irritation affecting the absorbent vessels passing through 
this gland may, the author conceives, cause such a degree of swelling, 
as would produce transient compression and closure of the common 



134 Twining on the Diseases of Bengal. 

biliary duct so as to prevent the passage of bile into the intes- 
tines and thus give rise to jaundice. So long as the obstruction is 
complete, the stools will be nearly white or of a very pale-gray co- 
lour. In cases of jaundice however, he remarks, attended with se- 
vere fever and intense gastro-enteritis, the colour of the stools will 
very often be different, in consequence of the blood which is poured 
out by the capillary vessels of the intestinal mucous membrane, as 
well as from other morbid secretions. 

" When previous Inflammatory disease at the capsule of Glisson has been at- 
tended with infiltration of coagulable lymph into the cellular structure of that 
part, at a remote period, and its subsequent absorption has left a degree of in- 
duration and constriction, a very slight enlargement of the lower gland," Mr. 
T. believes, " will effectually compress the common biliary duct, and he has 
seen its canal obliterated from that cause, exactly at the point of contact with 
the tumid and indurated gland." 

Mr. T. has also seen the cystic duct obliterated where it was in 
contact with the upper gland, in consequence of the enlarged and dis- 
eased state of the latter. But he does not apprehend that this could 
have any influence in the production of jaundice. 

Our author does not deny the influence which biliary calculi, or 
tumours of the pancreas, liver, or spleen, or scirrhus pylorus may 
occasionally have in producing icterus^ nor that in some rare cases 
the disease has been excited by mental emotions. He is unwilling, 
also, to place undue emphasis on the observations upon which his own 
views of the most frequent cause of the disease are based. He be- 
lieves, however, that should the latter upon more ample investigation 
be found to be correct, it will have an important influence upon our 
general treatment of the disease. 

According to Mr. T. the most successful plan of treating jaundice 
consists principally in depletion by the lancet and leeches, active 
purgation, the use of the warm bath and sudorifics, aided by low 
diet and quiescence, in the beginning of the disease, followed by 
milder purgatives, a small blister over the region of the gall-bladder, 
kept open for a long time. Subsequently a course of Cheltenham 
salts, or small doses of rhubarb and sal. polychrest, with gentle exer- 
cise, and frictions with camphorated liniment over the right hypo- 
chondrium are adviseable. At the same time it may be proper to 
allow a mild unirritating diet, in such quantities as shall improve the 
patient's strength. The disease may sometimes occur under circum- 
stances that forbid depletion; this Mr. T. conceives to be an unfor- 
tunate case, as he has but little confidence in other modes of treat- 
ment. 



Twining on the Diseases of Bengal. 135 

In cases of jaundice in which the stools indicate the entire absence 
of bile from the intestines, the author considers the use of mercurials 
to be of doubtful propriety. But when bile does pass into the duode- 
num, he admits that calomel may be useful in conjunction with the 
remedies already detailed. Excepting in cases in which there is tole- 
rably distinct evidence of the existence of biliary calculi, which he 
believes to be less frequently a cause of jaundice than is generally 
imagined, he doubts the propriety of having recourse to opiates. 

Whether the views of Mr. T. in regard to the pathology of jaun- 
dice be or be not correct, we cannot pretend to decide until we shall 
have had an opportunity of testing them by a series of actual obser- 
vations; but in respect to his plan of treating the disease, with one 
exception only, we believe it will be found to be in the generality of 
cases the only proper and successful one. The exception to which 
we allude is the indiscriminate administration of purgatives. Jaundice 
is not unfrequently connected with extensive irritation of the stomach 
and small intestines, and in these cases we are persuaded that the 
employment of purgatives to the extent recommended by our author 
would be decidedly injurious. 

The next chapter, (Chapter III. ) treats of diseases of the spleen. 
The whole of the observations presented by our author under this 
head are particularly interesting, not only from the frequency, seve- 
rity, and danger of these affections in particular climates and locali- 
ties, but from the peculiar morbid condition of the system, which the 
author has found to proceed and accompany them; and also from the 
modifications which are produced in the character and tendency of 
other diseases which happen to occur at the same time. 

Of the physiology of the spleen we know absolutely nothing, and 
of our acquaintance with its pathology nearly the same statement 
may with propriety be made. It is important then, that all the phe- 
nomena attendant upon the diseased conditions of this organ should 
be studied with care, not only that we may be led to correct views of 
their nature and treatment, but in order, if possible, to acquire from 
this source some knowledge of the functions which the spleen per- 
forms in the animal economy during a state of health. We cannot 
say that the observations of our author throw much light on either of 
these points; nor do we think that he has investigated in a very satis- 
factory manner the nature of the morbid phenomena by which disease 
of the spleen is so generally accompanied. Notwithstanding he tells 
us, that "instead of viewing the enlargement of the spleen, as the 
principal object for investigation, it mil be consistent with a correct 
view of the disease now under consideration to speak of the enlarge- 



136 Twining on the Diseases of Bengal. 

ment of the spleen, as one of the phenomena usually attendant on a 
peculiar description of constitutional disorder;" yet it is very evi- 
dent that he considers the latter to be intimately connected with, if 
not dependent on the former. In casting the eye over the list of 
symptoms which he has given us as those attendant upon diseases of 
the spleen, the reader will perceive that many of them are referable 
to an affection of the stomach and nutritive apparatus generally, and 
may exist independent of the splenic disease. In all probability, 
even in cases where the latter is present, they owe their origin to the 
same causes as gave rise to the affection of the spleen. In many in- 
stances, however, the latter would appear to be a secondary, and not 
a primary disease. In his account of the post mortem appearances, 
Mr. T. has omitted to notice the state of any other organ than the 
spleen. He has in this, as well as in other instances, committed an 
error very common with the English pathologists, that, namely, of 
directing his attention solely to the organ in which the anatomical 
indications of disease are most prominent, overlooking entirely the 
indications of disease in other parts derived from the symptoms which 
occur during life. It is from the physiological, combined with the 
anatomical study of diseases, that the most important results are to 
be anticipated. Were all the phenomena which the author describes 
as accompanying splenic disease actually dependent upon the latter, 
they would afford no slight support to the opinions of some modern 
physiologists, that the spleen is the centre of the organic nervous 
system. 

The symptoms accompanying diseases of the spleen are the follow- 
ing. General debility, paleness, and a deficiency of red blood in the 
capillaries, most remarkable in the pale and bloodless appearance of 
the conjunctivse, blueness or pearly colour of the sclerotica, and 
chlorotic discoloration of the face, tongue, and gums. The circula- 
tion is generally languid; the extremities are liable to become cold; 
the skin is pale, shrivelled, and dry. Females affected with enlarge- 
ment of the spleen are liable to suffer from amenorrhea — regularity 
of the menses is for the most part a favourable symptom. During the 
continuance of vascular engorgement of the spleen, the patients are 
very liable to haemorrhages, or to sloughing ulcers from slight wounds 
or bruises. When local inflammations exist, that healthy constitu- 
tional energy upon which the deposition of coagulable lymph, and by 
which we find injuries repaired, and the extension of ulceration and 
the progress of sloughing arrested, on ordinary occasions, seems to be 
in a great measure, if not entirely wanting. Foul gangrenous ulcers 
of the mouth and lips are liable to form from trifling causes, and often 



Twining on the Diseases of Bengal. 137 

without any apparent cause, producing a destruction of the teeth, and 
caries and exfoliation of the jaw bones. These affections of the 
mouth occur most commonly when mercury has been administered. 
Mr. T. is of opinion, that the cancerous, (gangrenous sore mouth of 
children,) as described by Dr. Cumming,* corresponds exactly with 
the splenic cachexy of Bengal now under consideration, and we find 
that among the few dissections reported by Dr. C. disease of the 
spleen is noticed. Haemoptysis and hsematemesis occasionally occur 
when the enlargement of the spleen is considerable: the blood which 
is vomited probably flows sometimes from vessels communicating di- 
rectly with the splenic vein, as the intumescence of the spleen has 
been observed in some cases to be immediately removed by these 
evacuations of blood. The blood drawn from the veins varies in ap- 
pearance. Sometimes it coagulates imperfectly without the separa- 
tion of the serum; in other cases the cruor is black and soft, and 
when exposed to the air its surface does not commonly assume the 
florid colour, as it does in blood drawn from a healthy subject. It 
seldom exhibits a buffy coat, excepting in cases attended with con- 
siderable fever, or acute pain in the side. Most patients are affected 
with a short and imperfect respiration, their general appearance 
evincing that the decarbonization of the blood is deficient. Any at- 
tempt to take active exercise excites panting and distress at the 
chest. Impaired appetite, difficult digestion, and imperfect assimi- 
lation of the food are among the usual attendants on vascular engorge- 
ment of the spleen. There is generally despondency and depression 
of spirits, inactivity of body, torpor of mind, and much muscular de- 
bility, even when the patients are not much emaciated. When fever 
is absent the urine is pale, often copious. In the latter stages of the 
disease oedema of the feet, and sometimes of the face and eyelids is 
present. In the majority of protracted cases, dysentery or ascites 
occurs. When the abdomen is much distended with fluid, the su- 
perficial veins on the sides of the chest and belly appear large and 
numerous, " showing the extent and degree to which the circulation 
in the internal organs becomes ultimately obstructed." 

The assemblage of symptoms above described constitutes "the en- 
demic cachexia of those tropical countries that are subject to paludal 
exhalations." 

" The enlargement of the spleen is the most frequent attendant on this ca- 
chexia, and its increase or subsidence generally corresponds with the unfavour- 
able or favourable changes, which are taking place in the constitution. It is, 
however, proper to observe here, that the constitutional symptoms sometimes 

* Dublin Hospital Reports, Vol. IV. 
No. XXV.— Nov. 1833. 13 



138 Twining on the Diseases of Bengal, 

exist in a very marked degree, where neither enlargement nor morbid sensibi- 
lity of the organ itself, are very palpable." 

Chronic enlargement of the spleen is stated to occur in adults of a 
pale, sallow, and unhealthy aspect without producing much suffering 
excepting that arising from the tumid state of the abdomen, shortness 
of breath, and occasional returns of indistinct ague. In children, 
however, affections of the spleen are always a very distressing and 
obstinate malady; in general quickly inducing a state of extreme ma- 
rasmus. 

Diseases of the spleen often occur in conjunction with dysentery, 
intermittent and remittent fevers, scorbutic affections, and sometimes 
with diseases of the liver. 

In the course of remittent fevers the tumefaction of the spleen 
sometimes comes on very suddenly, and proceeds quickly to an 
enormous extent. In extreme cases the diseased organ will fill more 
than half the abdomen, extending to the right of the navel, while its 
lower extremity reaches the left iliac region. 

"The progress of vascular engorgement of the spleen is more or less rapid, 
according to the injury which the constitution may have suffered from a damp 
climate, and the nature and duration of the fevers which the patient may have 
recently suffered." 

Most of the cases of vascular engorgement of the spleen in Ben- 
gal follow intermittent and remittent fevers; while tumid spleen is 
the most invariable consequence of acute and debilitating diseases af- 
fecting adults as well as children. Enlargement of the spleen is 
sometimes produced by "the combined influence of a damp climate, 
variable temperature, want of exercise, and insufficient nourishment." 
It may also be brought on by long-continued grief and distress of 
mind. 

In the greater number of instances the. affections of the spleen just 
described are unattended with local inflammation; there is, however, 
almost always morbid sensibility on pressure being made over the 
left hypocondrium during the early stages of enlarged spleen. Mr. 
T. believes that acute inflammation of the peritoneal coat of the spleen 
is a rare disease. It sometimes, however, exists without much en- 
largement of the organ, "and then the symptoms very much resem- 
ble pleuritis of the left side." 

The following are the morbid appearances in the spleen detected 
upon dissection. The most frequent are placed first in order. 

"A soft, rounded enlargement of the spleen, the texture less firm than in the 
healthy state, and easily broken if the finger be pushed abruptly against it. In 
some cases it is so much softened that it resembles a great clot of blood, wrap- 



Twining on the Diseases of Bengal. 139 

ped in a thin membrane. This varies in colour from black, to brown or blue, 
and in the extreme degree of softening, when we attempt to lift the tumid 
spleen, the fingers are thrust through the membrane, and the organ breaks 
down in the hands, becoming a putrid gore. This soft, globular enlargement 
from vascular engorgement most commonly attends, or follows, the severe re- 
mittent fever of the rains and cold season, attacking weak and unhealthy young 
persons. 

"Oblong enlargement of the spleen; the organ being more firm in texture 
than in its natural state, its edge thin and notched. The colour being some- 
times a pale-brown, though more generally a dusky-red. This morbid change 
of structure would appear to be the result of more slow and gradual degene- 
ration, which in its earlier stages has probably been attended with some inflam- 
matory condition of the internal structure of the spleen. In such cases we 
also find evidence of superficial inflammation, attended with adhesions to the 
adjacent parts, more frequently than in the rounded enlargement from simple 
vascular engorgement. 

" Opaque patches of various sizes, some of these extend over half the con- 
vex surface of the spleen, and are nearly an eighth of an inch thick, they may 
be deemed the result of albuminous depositions during superficial inflamma- 
tion. 

"Adhesions of the peritoneal coat of the spleen to contiguous viscera, which 
adhesions are by no means a general result of tumid spleen in Bengal. 

" In a few old cases, we find a more indurated and friable spleen, that breaks 
when handled without much force, like a piece of old moist cheese. 

" Still more rare is the firmer induration intersected with septa of condensed 
fibrous structure, to which we give the name of scirrhus. 

"Tubercles of various sizes, generally small, and of a gray or brown colour. 

" An organized coagulum in the splenic vein. 

" Encysted tumours. 

"Abscess of the spleen. 

" The four last mentioned morbid appearances are exceedingly rare in Bengal. 

" Besides the above appearances of disease, we sometimes see a uniform pale- 
white or milky colour of the peritoneal coat of the spleen? which tunic is un- 
usually tough like a thin bladder that had been dried and afterwards wet in hot 
water: the substance of the spleen being soft and flexible. This has been ob- 
served in the post mortem inspection of several persons who had been long 
subject to agues. In patients who have suffered from spleen disease and are 
destroyed by a purging, numerous small ulcers are found on the internal mem- 
brane of the great intestines, while the peritoneal coat appears either quite 
healthy or paler than usually: the mesenteric glands in such subjects are often 
enlarged." 

In regard to the treatment of splenic affections, the plan which 
Mr. T. has found most successful in cases of vascular engorgement, 
is "perseverance in a course of purgative medicines, combined with 
bitters and some preparation of iron; of which, small doses of the 
sulphas ferri appear to be the most efficacious." His usual formula 
in cases in which there is not much fever, is — R. Pulv. jalap., Pulv. 



140 Twining on the Diseases of Bengal. 

rhei, Pulv. columbae, Pulv. zingiberis, Potassse supertart. aa. Ji., 
Ferri sulphatis, 9ss.; Tinct. sennae, %'iv. ; Aquse menthae sat. ^x. M. 
Of this, the dose for an adu t is §jss., at 6 A.M., and repeated at 11 
A. M. For children, the dose is regulated so as to produce not less 
than three, and not more than four stools daily. "This medicine 
acts as a purgative, tonic, and diuretic." When the patient is very 
costive, Mr. T. adds Pulv. scammon. comp. ^\. to the mixture, while 
for very delicate and emaciated subjects who are easily purged, he 
substitutes compound tincture of cardamoms for the tincture of senna; 
and when there is any disposition to intermittent fever the addition 
of 9ss. Sulph. quinise is made to the powder. In obstinate cases the 
author has found it useful to change the prescription occasionally. 
Thus, after continuing the first mixture for ten days, he omits it and 
directs for an adult, Ext. comp. colocynth. grs. viij., Gambog. grs. ij. 
in pills at bed-time, and xx. gtts. Tinct. ferri muriat. in a glassful of 
water, with Tinct. gentian, comp. 3j«> at 7 o'clock, A. M. and re- 
peated at 11 A. M. After continuing these remedies for five days, 
the use of the first mixture is resumed for ten days longer, and then 
half a drachm of the powder of black myrobalan with half a scruple 
of black salt every morning, and two grs. sulphate of iron and two of 
aloes in pills at bed-time.* 

At any time during the treatment, if febrile symptoms occur, the 
above remedies are omitted; a dose or two of jalap is given, and bleed- 
ing or leeches resorted to. In a few cases enlarged spleen is at- 
tended with febrile catarrhal symptoms; these are to be removed by 
direct depletion, purgatives and the tepid bath, before commencing on 
the mixture of sulphas ferri. 

In Europeans labouring under splenic disease, when the strength 
is not much reduced, Mr. T. found bleeding to be required, with the 
application of from four to ten leeches over the region of the spleen 
every second day. Whenever fever exists, or bleeding is demanded, 
he has found it beneficial to direct a purge of compound powder of 
jalap or of scammony and cream of tartar, with a grain of gamboge 
daily for a few days before the mixture containing sulphate of iron is 
prescribed. 

In treating diseases of the spleen, a careful attention, our author 
remarks, is necessary to regulate the patient's diet. Whenever fever 
or local inflammation is present, the diet must be of the mildest and 
most unirritating kind. In the early stage of vascular engorgement, 

* The black myrobalan is the small, black, withered, and dried unripe fruit 
of the Terminalia chebula, and the black salt a combination of certain propor- 
tions of black oxyd of iron, sulphur, muriate of lime, and muriate of sodse. 



Twining on the Diseases of Bengal. 141 

when the strength is not much reduced, with only occasional slight 
pyrexia, the diet should consist of tea, bread, sago, gruel and chick- 
en, or kid broth in very small quantity. But in more chronic cases a 
portion of roasted or boiled meat and curry may be allowed. In these 
cases, Mr. T. thinks that a small quantity of port wine and water, or 
beer may be taken with benefit at dinner. For ourselves, we should 
consider either of doubtful propriety. 

In chronic affections of the spleen great advantage is derived from 
the application of leeches daily or every second day over the left hy- 
pochondrium. The patient at the same time persisting in a moderate 
course of purgatives and some preparation of iron. The diet should 
be spare, with only a small quantity of meat or fried fish? vinegar 
or pickles may be taken at dinner. 

" Blisters or issues over the region of the spleen are of service, but we should 
be careful of applying- them to emaciated, leucophlegmatic, or dropsical sub- 
jects, during- the rainy season, as sloughing ulcers are then liable to be excited 
by them. Much benefit is derived from a flannel bandage or broad belt of flan- 
nel applied moderately tight, so as to support the weight of the spleen, and it 
is important that the whole belly, but especially the left side, should be rubbed 
for an hour twice a day with heated flannel. If there be an open issue, the 
side may be rubbed round that. Liniments are not of much use." 

In cases of splenic disease, the author warns in the strongest terms 
against the use of mercury in any quantity. It produces, he states, 
almost invariably, extreme debility, depression and exhaustion — pre- 
mature salivation, destructive ulceration and horrible sloughing of 
the gums, lips, and cheeks. 

Mr. T. has given an interesting section on the remedies employed 
by the natives of Bengal, for disease of the spleen, which we have 
reluctantly to pass over. 

Our readers, we are convinced, will need no apology for the space 
we have occupied in our notice of the present chapter of Mr. T. 's 
work; the importance of many of the author's observations on dis- 
eases of the spleen, required that a very full analysis of them should 
be presented, and in so doing, we have left ourselves no room for 
comment. 

The next subject of which our author treats is cholera, (Chap. 
IV.) Differing as we do on many points, from the views advanced 
by Mr. T., in relation to the pathology of this disease, and dissent- 
ing from him as to the propriety of some parts of the plan of treat- 
ment he has laid down, we felt desirous of entering into a very full 
examination of this portion of the work. As this, however, in order 
to do full justice to the subject as well as to the author, would lead 

13* 



142 Twining on the Diseases of Bengal. 

to a discussion of the nature and proper treatment of cholera, and 
consequently extend our review to an unreasonable length, we are 
under the necessity of passing over the whole chapter. This we do 
with the less regret, from the persuasion that our readers have by this 
time become nearly tired of the subject, important as it is in every 
point of view. We may remark, however, that our author is a 
staunch non-contagionist. In the concluding section of this chapter 
he presents a general view of the facts which bear upon the subject 
of contagion in cholera, all of which are inconsistent with the suppo- 
sition of the disease being propagated from the sick to the well or by 
fomites in the proper sense of the ^erm. 

The fifth and last chapter of the work treats of fevers; or, more 
properly speaking, it comprises some general observations on the pa- 
thology and treatment of the forms of fever most prevalent in Bengal. 
These are intermittents, the common continued fever of the hot 
season, the remittent fever of the rains, and the insidious congestive 
fever of the cold season. Although most frequent during the seasons 
specified, these fevers occur occasionally at all periods of the year. 

Mr. T. denies most positively that fever depends invariably on 
local inflammations. | 

'* For although," he observes, "our Bengal fevers are probably more gene- 
rally attended with inflammation of some organs, at particular stages of the dis- 
ease, and more frequently followed by obstinate and excessive visceral disor- 
ders, than the fevers of any other country, still we have strong evidence that 
fever in its early stage differs widely from the commencement of local inflam- 
mation." 

Now this " strong evidence" we are gravely told is deducible from 
the extensive, nay almost general affection of the system with which 
fever commences; and then we are furnished as additional proof with 
the celebrated definition of Dr. Fordyce. It is very evident from the 
tenor of Mr. T.'s remarks on the pathology of fever, that he is en- 
tirely unacquainted with the doctrine against which he has protested, 
and we regret that he has not had an opportunity of acquiring a 
knowledge of it. Had he studied it with care, his opinions in regard 
to the nature and treatment of fevers would in all probability have 
undergone a very considerable modification. His own observations 
affording most striking illustrations of the correctness of the pa- 
thology of fever advocated by the physiological school. 

The principal peculiarities which mark the intermittent fevers of 
Bengal, appear to the author to be the great frequency and obstinacy 
of the visceral disease by which they are in general attended. In the 
early stages, or within two or three weeks from their commencement, 



Twining on the Diseases of Bengal. 143 

in persons of robust habit, there is very often disordered function 
and secretion of the digestive organs, especially the stomach, with 
congestion of the brain — sometimes tolerably distinct evidence of an 
inflammatory condition of the latter organ or of its membranes. The 
liver also often shows signs of disorder at an early period — hepatic 
abscess is not however frequent at more remote periods. In patients 
who have an unhealthy look, the spleen will more commonly be found 
diseased, this organ exhibiting various combinations of inflammatory 
and congestive affection, that terminate in induration of the most ob- 
stinate character. The mesenteric glands and the cellular structure 
at the root of the mesentery and mesocolon are often found more or 
less diseased in protracted and obstinate cases. The lungs are not 
unfrequently the seat of congestions and sub-acute inflammation in 
obstinate quotidians and quartans. 

We cannot conceive how the author can reconcile the statements 
contained in the following paragraph with his general denunciation 
of the physiological doctrine of fevers. 

" I would not be disposed to assert, that the intermittent fevers of this 
country are to be looked on as the invariable concomitants of local inflamma- 
tions, or diseases of structure; but I know they are very generally found to be so, 
by those who examine their patients with accuracy, and that obstinate inter- 
mittents are most easily and permanently cured by those practitioners who 
evince the greatest dexterity in detecting the coexistent disorder, and the 
greatest skill in removing it. I am quite ready to acknowledge that many in- 
cipient intermittents are perpetuated by, or connected with mere functional 
embarrassment, which is very often seated in the mucous surface of the sto- 
mach and intestines, the indications of the more transient congestions, being in 
all cases slight and indistinct, and we occasionally, though rarely, see a regular 
paroxysmal fever of long existence, in which we cannot detect any evidence of 
predominant local affection." 

The expression, " mere functional embarrassment" of the stomach 
made use of above, either implies disease of the stomach, or it means 
nothing. The fact is, Mr. T. seems to be afraid of being led to the 
very conclusion to which all his observations seem so distinctly to 
point, that fever, namely, whenever it exists, is the invariable con- 
comitant of some local irritation of greater or less intensity. 

The author very properly denies the universal dependence of in- 
termittents upon malaria. 

" It is abundantly evident to every medical man," he remarks, "in Bengal, 
that intermittents are intimately connected with the diurnal changes of tempe- 
rature which take place at the commencement of the cold season." 

When cold nights and foggy mornings commence and the heat of 
the day is much decreased, even in situations which may be consi- 



144 Twining on the Diseases of Bengal. 

dered the most favourable for the production of malaria, he is of opi- 
nion, that abundant facts would oblige us to ascribe those fevers in a 
considerable degree to abrupt changes of temperature. 

We cannot follow in detail the very excellent observations of the 
author upon the proper treatment of intermittent fever. We can 
only notice his experience of the good effects of bleeding during the 
cold stage. The abstraction of blood at this period, he has found in 
the greater number of cases to arrest the paroxysm ; that is, the oc- 
currence of the hot and sweating stages is prevented; and the ma- 
jority of patients who have been treated with a sufficient course of 
mild purgatives before the bleeding, will not have a return of the dis- 
ease, provided they are well clothed and not exposed to atmos- 
pherical vicissitudes. In this manner we cut short the fever, and 
guard against those ulterior visceral engorgements and indurations of 
internal organs, by which it is too often prolonged until the constitu- 
tion is completely ruined. The only period of the cold stage at which 
bleeding will be proper, Mr. T. states to be at the commencement 
of the rigor, or just when the coldness and shivering are completely 
established. In general, he has found it sufficient to take twelve 
to fifteen ounces from an adult, and in the most robust Europeans he 
would limit the quantity to be taken at one bleeding to twenty 
ounces. The patients should be permitted to lie quiet for an hour or 
two after the bleeding, and not heated with too much bed-clothes; 
they should be supplied with a cup of warm tea or gruel, or thin warm 
sago soon after the arm is tied up. 

" The requisites to insure success from bleeding 1 in the rigor, are 1st, the 
preliminary course of moderate purging-; 2d, that the blood be taken from a 
large orifice quite as soon as the coldness and rigor are fairly established; 3d, 
that the patient be bled in the recumbent posture, and no more blood taken 
than arrests the paroxysm.'* 

In robust plethoric patients, who during the intervals of the pa- 
roxysm complain of head-ache and morbid tenderness on pressure over 
the abdomen, and pain or uneasiness in the chest, the disease will 
seldom be arrested by the first bleeding; in many cases they will have 
repeated paroxysms, in each of which the use of the lancet will be re- 
quired. Patients also in whom the paroxysm, more especially the 
cold stage, is attended with vomiting, Mr. T. has found to require 
the repeated abstraction of small quantities of blood during the 
rigors. 

The continued fever of the hot season of Bengal generally attacks 
suddenly. It is sometimes ushered in by rigor, and occasionally the 
attack commences with violent and long-continued vomiting of green 



Twining on the Diseases of Bengal. 145 

bile. The prominent symptoms of this form of fever are heat of the 
surface, increased frequency and fulness of the pulse, great thirst 
and head -ache. There is a sudden prostration of strength, and in 
some cases a degree of stupor. 

" Local inflammations " remarks the author, "are manifest very early; the 
organs principally affected are the brain, the stomach, the cellular structure 
around the duodenum, and at the root of the mesentery and the liver." 

The progress of the disease, if left to itself, is usually rapid, and the 
termination fatal. The patient is distressed with restless nights, 
and after some time delirium ferox takes place, this is succeeded by 
stupor which ends in death. 

The usual causes of this disease are insolation, violent exercise in 
the hot season, bathing when overheated, and the excessive use of 
wine or ardent spirits. 

The treatment advised by the author consists in active depletion, 
leeches to the head, abstinence from food, and the other remedies 
usually prescribed in what are termed inflammatory fevers. The only 
objections we have to make to this plan of treatment, as it is directed 
to be carried into effect by Mr. T. are the omission of leeches to the 
stomach in cases attended with " fulness and tension of the epigas- 
trium, and morbid heat of the belly," and his profuse administration 
of active purgatives, 4t so as to procure not less than four free evacu- 
ations daily." In an insidious form of this fever, described by the 
author, attended with decided gastro-enteritis and obscure cerebral 
affection, it is true the frequent application of leeches to the epigas- 
trium and head, and a diet of tea or very thin barley water, are very 
properly insisted upon ; but even in these cases, where the existence 
of inflammation of the stomach and bowels is acknowledged, his fond- 
ness for purgatives leads him to advise blue pill and compound ex- 
tract of colocynth at night, and jalap and compound powder of scam- 
mony in the morning daily, or when they are rejected, senna tea or 
Epsom salts every hour until they operate freely. It is in vain to as- 
sert that the propriety of these remedies is proved by the general 
removal under their exhibition of the disease. We know that the 
repeated administration of active purgatives does increase irritation 
of the stomach and bowels, and that the very forms of fever our author 
describes, are mors promptly and effectually cured without than with 
the use of purgatives, provided leeches be applied in sufficient num- 
bers to the head and stomach. 

The remittent fevers of Bengal, as described in the chapter 
before us, do not appear to differ materially in their symptoms from 
the bilious fevers of the southern states. 



146 Twining on the Diseases of Bengal. 

"The closest attention to clinical observations," remarks Mr. T. "as well as 
the result of post mortem examinations, convince me that remittent fevers in 
Bengal are invariably connected with local congestions, which often run rapidly 
into inflammations, attended with much interstitial effusion. The seat of these 
local affections is found principally in the stomach, intestines, cellular structure 
about the duodenum, and at the root of the mesocolon, more especially where 
it passes across the spine. The principal disease is also often found in the 
spleen, liver, brain, or lung's." 

The treatment advised in cases of remittent fever, is active deple- 
tion adapted in its extent to the violence of the symptoms and 
strength of the patient, and repeated according to circumstances. 
The free use of active purgatives, especially large doses of calomel; 
the latter to be omitted, however, in cases in which the spleen is af- 
fected. The advantage of salivation appears to the author to be pro- 
blematical. 

"In most cases it is requisite to bleed freely in the early stage of the first 
and second paroxysm, after that we must be more cautious; but at any period, 
when the pyrexia and arterial action is increasing 1 , it is always safe and useful 
to apply a few leeches to the head or epigastrium, according as the predomi- 
nant symptoms may indicate their necessity." 

Such are the remedies for the height of the paroxysm. In regard 
to them precisely the same remarks apply as were made above in re- 
ference to the author's treatment of continued fever. "When the pa- 
roxysm abates, sulphate of quinia is directed, to prevent its return; 
unless the brain be much affected or local inflammation is evident. 
These affections should always be removed before the quinine is com- 
menced with. But even when they are present the author thinks that a 
few small doses of quinia given in solution, during the period of apy- 
rexia, will enable us to subdue the disease with greater ease. From this 
opinion we must, however, dissent; in the treatment of all fevers the 
complete reduction of the symptoms of local inflammation by appro- 
priate remedies, especially the free application of leeches, will more 
effectually prevent the return of the paroxysms or exacerbations than 
the early exhibition of quinia, bark, or other tonics. 

The insidious congestive fever of Bengal is characterized by 
the slightness and obscurity of the symptoms at its commencement. 
The earliest symptoms are usually slight lassitude, weariness in the 
loins, transient pains in the joints, and inaptitude to continue any 
intellectual pursuit with the degree of vigour and satisfaction natural 
to the individual. There is some shortness of breath, increased se- 
cretion of urine, and unrefreshing sleep. The pulse and appetite are 
but little altered, but food is not relished as usual, and the patient is 
induced, by a sense of weariness to take an increased quantity of 



Twining on the Diseases of Bengal 14? 

wine* After from four to ten days some degree of dry heat of the 
skin is observed, the urine becomes scanty and high-coloured, the 
appetite for food nearly ceases, there is some thirst, and great increase 
of languor. The patient supposes he has a cold, and has recourse to 
some domestic treatment, by which, generally, his disease is increas- 
ed. Business and amusement are still attended to, until the disease 
has progressed for many days. It is sometimes the end of the second 
week before medical aid is solicited* Even then no very distressing 
symptom is experienced. The pulse is soft, frequent, and weak; the 
wrist tremulous; the tongue nearly natural; there is anxiety, and a 
sense of weariness in every part of the body. A constant pain is ex- 
perienced in the forehead, of which the patient may not complain 
unless particularly questioned. The nights are restless, and business 
can no longer be attended to. There is sometimes a weakness of the 
eyes, and a sense as if the eye were bruised when pressure is made 
upon the lids; the face is sometimes flushed, and the hands warm and 
dry; occasionally the extremities are rather cold, and the face has a 
livid or chlorotic aspect. The bowels up to this period are usually 
costive; when calls to stool are frequent, the discharges are extremely 
scanty. On examination, some fulness and tension will be discovered 
at the epigastrium and across the hypochondria. 

If the case be neglected or improperly treated the febrile symp- 
toms slowly increase, but usually very little alarm is excited until 
delirium occurs at night, and the obscure pyrexia is accompanied in 
the day by drowsiness and an approach to stupor. The eyes become 
red, the tongue foul, brown, and dry; the urine is high-coloured, and 
thirst is experienced when the patient is not in a state of stupor. Oc- 
casionally there is intense yellowness of the skin and eyes, and red- 
coloured urine, especially in cases attended with much oppression at 
the chest and hurried respiration. Sometimes a soreness of the whole 
body is complained of, and a morbid sensibility is experienced when 
we press over the glands and along the course of the absorbents. In 
these cases there is much febrile heat, evening exacerbations are com- 
mon, and often a very fretful state of mind. A remarkable feature 
in this disease is the long-continued delirium, or a state of apparent 
insensibility to external objects, with picking at the bed-clothes, or a 
constant movement of the hands, as if in search of some imaginary 
object. Notwithstanding these symptoms, recovery will take place. 
Most protracted cases of this fever assume a remittent form by the 
eighth or ninth day. 

Post mortem examinations, we are told, do not discover much 
change of structure different from that found after remittents. In a 
few rare instances, when patients have died after a protracted fever 



148 Twining on ike Diseases of Bengal* 

of this sort, Mr. T. has found superficial ulceration of the mucous 
membrane of the small intestines. 

" In the cure of this form of fever we have the same general objects in view," 
remarks the author, "as in the treatment of common continued fever, but we 
see less morbid arterial action to subdue, and until the disease is far advanced 
little apparent local affection to indicate a particular line of practice." 

The remedies directed are bleeding, purging, occasionally an eme- 
tic, abstemious diet and rest, the tepid bath, leeches over the liver 
and to the head, and in some cases a blister to the abdomen. 

"Blood-letting," the author informs us, "is a very essential part of the treat- 
ment. I do not remember," he states, "ever to have seen a patient that died 
•who had been bled from the arm at an early period? though the subsequent 
treatment may have been so unskilfully conducted as to insure a prolonged 
disease, in the cure of which much difficulty was experienced." 

The last section of the chapter on fevers contains a description of 
a strange affection of the mucous membrane of the nostrils, to which 
the natives of Bengal are liable, which want of space prevents us 
from noticing. 

In concluding this review, it is unnecessary for us to express for- 
mally our favourable opinion of the work of Mr. T. The comments 
already made, and the very copious analysis of its contents we have 
presented to our readers indicate fully the importance we attach to 
the observations of the author on the diseases of which he treats. 
We have, it is true, found it necessary to express our dissent from 
some of his pathological views, and to deny the correctness of a few 
of his therapeutical directions. In so doing we believe that we are 
sustained by innumerable facts, and a series of personal observations, 
the result of many years experience in the treatment of morbid affec- 
tions bearing a close analogy to those described in the volume before us. 

We have already alluded to some defects in the style of our au 
thor. He appears in particular to have a strange aversion to the use 
of the articles a and the, which he omits in many instances, where 
the sense of the passage, to say nothing of common usage, requires 
the insertion of one or other of them. In the passages quoted in the 
present review the articles printed in Italics are wanting in the ori- 
ginal. We protest against the use of epigastre and hypocliondre adopt- 
ed by the author for epigastrium and hypochondrium, as well as against 
the word proclivity, which he uses almost invariably instead of the 
proper technical term predisposition. With all its faults, however, 
the work contains a collection of valuable observations, from the care- 
ful study of which, the young practitioner in particular will derive 
much useful information in regard to the pathology and treatment of 
an interesting and important class of diseases. D. F. C. 



Medical Statistics. 149 



Art. XII. Mortality of the Metropolis. — A Statistical View of the 
Number of Persons reported to have Died of each of more than One 
Hundred kinds of Disease and Casualties within the Bills of Mor- 
tality in each of the Two Hundred and Four years, 1629-1831, 
#c. &c. #-c. By John Marshall, Esq. 1 Vol. 4to. London, 
1832. 

The Population Returns of 1831, with a Statement of Progress in 
the Inquiry regarding the Occupation of Families and Persons and 
the Duration of Life; an Historical and Descriptive Account of 
London, Westminster, and other parts of the. Metropolis', a Compa- 
rative Account of the Population of Great Britain, in 1801, 1811, 
1821, and 1831, fyc. fyc. fyc. London, 1832. 

Natural and Political Observations mentioned in a following Index* 
and made upon the Bills of Mortality. By John Graunt, Citizen of 
London. With reference to the Government, Religion, Trade, 
Growth, Ayre, Diseases, and the several changes of the said city. 
London, 1662. 

JMeDICAL statistics, or as it is occasionally denominated political 
arithmetic, constitutes at the present time, an object of deep interest 
to the physiologist and philanthropist, as well as to the states- 
man. In England and in some of the countries of the European 
continent, many valuable publications affording information of a 
highly interesting and useful character, and presenting results of a 
remarkable and often of an unexpected nature, have been recently 
presented to the public; and to those who are conversant with the 
scientific and medical literature of this country, it need scarcely be 
stated that the subject has begun successfully to engage the attention 
of American writers. The progress made in this department of 
knowledge, and the zeal and success with which it is studied,, should 
be to all a source of great satisfaction, for viewed in every light the 
science of medical statistics must be considered as of considerable 
importance, and as fully entitled to the attention it receives. 
As Dr. Hawkins well remarks, it is the key to several sciences; 
opening in a manner the most convincing, simple and summary, their 
gradual progress, their actual condition, their relations to each other, 
the success which they have attained, or the deficiencies which re- 
main to be supplied. Its application to the objects of government, 
Dr. H. adds, has created political economy; and there is reason to 
believe, that a careful cultivation of it in reference to the natural 
No. XXV.— -Nov. 1833. 14 



150 Medical Statistics. 

history of man in health and disease, would materially assist the com- 
pletion of a philosophy of medicine, by pointing out to the physicians 
of every part of the world the comparative merits of various modes 
of practice, the history of disease in different ages and countries, the 
increase and decrease of particular maladies, the tendency of certain 
situations, professions, and modes of life to protect or to expose; and 
by indicating, as the basis of prognosis, those extended tabular views 
of the duration and termination of diseases which are furnished at 
successive periods, by hospitals and civic registers. 

Medical statistics is comparatively anew science, and constitutes, 
we believe, one of the many branches of useful knowledge, for the 
first idea of which we are indebted to England. This at least has 
been inferred from the circumstance, that although a few useful facts 
relative to mortality, births, &c. may be found scattered in the wri- 
tings of the older medical and other authors of the continent, no in- 
dividual appears to have taken up and investigated those subjects in 
a regular and systematic matter previous to the middle of the seven- 
teenth century, when Capt. John Graunt, citizen of London, pub- 
lished the work whose title will be found among those prefixed to 
this article. "Capt. John Graunt, of London, has the honour, says 
Dr. Hawkins, of being the first writer who ever directed the attention 
of the world to the comparative births and deaths of different cities, 
years, seasons, sexes; to the comparative mortality of disease; to the 
proportion of births and deaths, and to the relation of the town to 
the country in these respects." "He displays a singular genius 
for observations, in a field where no footstep can be traced be- 
fore his own. He was really the creator of the new science of 
statistics." 

In this field of investigation, Graunt has been followed by Suss- 
milch, Odier, Heberden, Blane, Richman, Finlayson, Villerme, 
Quetelet, Casper, Orsini, Gordini, Balbi, De Sagras, Seybert, 
Emerson, Storer, and other writers in Europe and America who 
have furnished information of great value on different points con- 
nected with the subject in question. 

But among the numerous publications which have appeared on the 
subject, there are few entitled to more respect, as well on account of 
the mass of valuable information it conveys, of the manner in which 
this is arranged, as of the localities to which it has reference, than 
the volume which stands at the head of our list. The author informs 
us, that his attention had long been directed to the extent and mor- 
tality of London, and that having been favoured by a friend con- 



Medica I Statistics. 151 

nected with one of the insurance offices, with a complete set of the 
bills of mortality, published annually for more than two hundred 
years, he was excited by curiosity in the first instance, rather than 
by any specific design, to ascertain what their investigation might 
lead to and develope. 

Having gone through the whole period, he threw the details into a 
form, to enable him to see clearly what conclusion could be drawn 
from them. The manuscript was afterwards shown to some eminent 
medical practitioners who recommended its publication. 

Presuming that some of our readers take an interest in investiga- 
tions of this kind, and convinced ourselves of the high importance of 
the subject, we have drawn up an abstract of that part of Mr. Mar- 
shall's work which relates to the movement of the population of 
London and England, and to the causes of the mortality in the former. 
But with a view to render the article more complete and interest- 
ing, we have occasionally borrowed from Capt. Graunt's volume, 
and from the population returns of 1831 — the preparation of which is 
assigned to Mr. Rickman the assistant-clerk of the house of commons; 
and have likewise compared, on several points, the results obtained 
in England, with, those furnished by similar researches in France and 
other places. 

From all we can learn on the subject, it appears that the first of 
the continued weekly bills of mortality extant at the Parish Clerk's 
Hall, began on the 29th of December, 1603, "being" as Mr. Graunt 
remarks, " the first year of King James his reign; since when a weekly 
accompt hath been kept there of burials and christenings." It is 
true, that parish registers of marriages, christenings and burials origi- 
nated in England in 1592, and were published in 1594, in conse- 
quence of the plague which existed the preceding year. But they 
were discontinued after the 18th December, 1597,' — the plague 
having then ceased; for it seems probable, as Mr. G. surmises, 
that "the rise of keeping these accompts was taken from the 
plague." 

In 1603, when the publication of the uninterrupted series of bills 
commenced, the reports were received from only thirteen out parishes, 
in addition to ninety-six within the walls of the city of London — that 
of St. James's Duke's Place not being then included. From that 
period to 1629 other parishes were successively added, and in the 
latter year twenty-six parishes in addition to the ninety-seven within 
the walls, (St. James's Duke's Place beingnow included,) made weekly 
returns. Since then the number of out parishes included within the 



152 Medical Statistics, 

bills of mortality, have been increased to fifty, embracing London 
without the walls, the borough of Southwark and the city and liber- 
ties of Westminster. 

In the first bills, from 1 603 to 1625, the aggregate weekly number of 
burials and christenings in the various parishes was reported . But nei- 
ther in these reports nor in the annual bill was any thing said of the 
diseases occasioning the mortality, except of the plague, — the number 
of individuals who had fallen victims to this disease being separately 
stated. In the last mentioned year, 1625, the number of burials in 
each separate parish was for the first time mentioned ; but it was only 
in 1629, that the reports of diseases and casualties, together with the 
distinction of the sex of those who had died, were first presented to 
the public. 

" Such," as Mr. Marshall remarks, " was the origin and progress of the account 
of the burials and diseases of that part of the metropolis within the bills of mor- 
tality from 1592 to 1629, since which date a copy of the returns has been sent 
weekly to the secretary of the home department of state, and the right honour- 
able the lord mayor, and an annual account has been, and still continues to be 
published, and generally circulated by the several parish clerks, amongst their 
fellow parishioners, under the imposing title of ' A general bill of all the 
christenings and burials within the city of London, and bills of mortality from De- 
cember , to December , according to the reports made to the King's 

most excellent Majesty, and to the Right Honorable the Lord Mayor, by the 
Worshipful Company of Parish Clerks.' " 

Before proceeding further, it may be proper to offer a few words 
in relation to the officers to whom was, and is still entrusted the pre- 
paration of the bills of mortality, and to the source whence they 
derive their information respecting the nature of the diseases, and ca- 
sualties occasioning the deaths reported. These officers are denomi- 
nated Parish Clerks, and constitute a company which was incorporated 
as far back as 1233, under the title of the Fraternity of St. Nicholas. 
In 1611 they were reincorporated under the title of the Worshipful 
Company of Parish Clerks, and in 1625 their bills of mortality are 
stated to have acquired a general reputation. As regards the manner 
in which the knowledge on which the bills are founded, is obtained 
by those officers, or in other words the authority upon which the 
report of diseases is founded, Mr. Marshall truly remarks, that consi- 
dering the country and city concerned in these reports, the exalted 
sanction under which they are made, and the public officers to whom 
they are presented, it would be natural to suppose that the office of 
reporting would be assigned to some of the most acute, discerning, 
enlightened and industrious members of the medical profession, 



Medical Statistics. 153 

" But what will the distant inquirer say," he adds, "when I inform him, as 
it is my duty to do, that the reports rest upon the authority of a parcel of 
elderly females, designated old women, by those who indulge in vulgar preju- 
dices against the returns." 

These women are two in number in each parish, and are denomi- 
nated searchers. They are appointed by the parish clerks, under the 
sanction of the parochial authorities. 

" When any one dies," says Capt. Graunt, " then either by tolling or ringing 
of a bell, or by bespeaking of a grave of the sexton, the same is known to the 
searchers, corresponding with the said sexton. The searchers hereupon repair 
to the place where the dead corpse lies, and by the view of the same, and by 
other inquiries, they examine by what disease or casualty the corpse died. 
Hereupon they make their report to the parish clerk." 

To our great surprise, Mr. Marshall entertains a favourable opinion 
of this mode of reporting, and of the class of individuals from which the 
searchers are selected. After stating the manner in which these reports 
are drawn, he asks what more could be done by the most skilful medical 
practitioner, except by the one who attended the person previous to 
demise. He cannot discover that there exist any rational motive for 
misrepresentation, except in a few cases, perhaps, of a desire on the 
part of the friends of the deceased to conceal the fact, when the death 
may have been occasioned or accelerated by indulgence in some 
vicious practice. But such cases, he thinks, supposing them to oc- 
cur at all, will of late years, at all events, have been too few to af- 
fect the general interest of the bills. 

" The searchers so called, he affirms, are personages, not perhaps possessing 
the first Order of mental acquirement and discrimination; but possessing plain 
good sense, matronly deportment, and much practical experience in diseases, 
affording as fair a guarantee for exactitude in their reports as is likely to be ob- 
tained in any other manner, without consulting the medical practitioner by 
whom the disease was attended previous to the demise: a medical practitioner 
could probably report more technically, but not more intelligibly." 

The expression of this opinion is the more astonishing, as, accord- 
ing to Mr. Marshall's statement, his own countrymen entertain a 
different one, and there prevails in the metropolis a general censure 
and disregard respecting the reports founded on the character of 
those from whom they are obtained. We cannot indeed conceive 
how an author of Mr. Marshall's intelligence and information, can 
for a moment uphold such a plan of reporting. It is radically defec- 
tive, whether we have regard to the manner in which the informa- 
tion required is obtained, or to the presumable character and ac- 
quirements of the individuals charged with collecting it. It would 

14* 



154 Medical Statistics. 

be a matter of considerable difficulty for any class of persons, how- 
ever well informed, to decide, from the inspection of a corpse, or 
from such other sources of information as the searchers can have ac- 
cess to, respecting the seat and character of the disease which has 
caused the demise of an individual whose remains they are called 
upon to inspect. Physicians themselves would often be sorely 
puzzled to arrive, from such data alone, at a satisfactory conclu- 
sion, and surely the difficulty must be infinitely greater to indivi- 
duals of the female sex, who have not enjoyed the benefit of even 
the elementary portion of a professional education. They may pos- 
sess, for all we know to the contrary, the good and matronly de- 
portment Mr. M. concedes to them; but it will be not the less 
true, that as they pursue no regular studies, and are, from the na- 
ture of their duties, in constant attendance on the dead, not on the 
sick, they cannot be supposed to acquire much experience in disease. 
Owing to this circumstance, and to the sources of information within 
their reach affording but slender data from which to arrive at a deci- 
sion, it is not unreasonable to presume that errors of a very gross 
character inevitably creep into their reports. But this objection to 
the searchers is principally founded upon the difficulties incident to 
the mode of reporting adopted. Others of a more serious kind may 
be found. Mr. Graunt, while maintaining, though for reasons very 
different from those assigned by Mr. Marshall, that the authority 
of the searchers is sufficiently good, and that it is of no importance 
whether the disease reported, be exactly the same as physicians " de- 
fine it in their books," provided the principal symptoms are given; 
Mr. Graunt, we say, recognised in the searchers of his times a great 
fund of ignorance, and even accused them of being open to bribery 
by those who wished to conceal the disease of which their friends had 
died. Now, we have reason for considering them as ignorant, and no 
more honest now than they were one hundred and fifty years ago, for 
Dr. Hawkins, in speaking of those of the present time, says they are 
dismissed with a gratuity, and are satisfied with the first answer 
given to them by the relatives of the deceased. Influenced by these 
circumstances, and entertaining different views from Mr. Graunt re- 
specting the necessity of accuracy, we cannot help believing that 
much advantage would be obtained in England from a polite dismis- 
sal of all those ladies, and the adoption of a system different from 
that at present in force; such for instance as that adopted among us^ 
or the one in operation in France, as they both appear to be far pre- 
ferable in every respect to the one in question. 



Medical Statistics. 155 

We cannot dismiss the subject of the searchers, without noticing 
in a brief manner an opinion expressed by Mr. Marshall, who, after 
speaking of those females, remarks that — 

" It may serve in some degree to assuage English vanity to know that over 
the greater part of continental Europe, the duties of attendance during 
parturition are wholly performed by females, who enjoy a respect and distinc- 
tion in society beyond that of the male practitioner in physic and surgery. Why 
then should the reports of diseases in London be impugned for being made by 
females?" 

Now, in this extract we discover two points on which that gentle- 
man appears to us to have erred materially. The first relates to the 
supposed higher standing, on the continent of Europe, of mid wives 
than of the regular members of the medical profession, and the second 
to the equality which Mr. M. seems disposed to believe exists, 
on the score of character and acquirements, between those mid- 
wives and the old matrons of whom we have been speaking. We 
confess that this is the first time we have heard that midwives en- 
joyed in any part of the world the least degree of superiority as re- 
gards respect and distinction in soceity over medical or surgical 
practitioners; and we doubt whether any one, conversant with the 
state of the profession in Europe, — who knows from what class of 
society accoucheuses are derived, as well as the inferiority of their 
education compared with that of physicians whose professional studies 
must necessarily embrace a much wider range of subjects, and be 
preceded by classical instruction totally unlooked for in the others, 
will ever feel disposed to join in opinion with Mr. Marshall. But 
while maintaining this, we must be allowed to affirm, that between 
the continental midwives and the metropolitan searchers, no parallel 
can be drawn. The former are regularly educated on the various 
points connected with the branch of the art they are destined to 
practise. They go through several courses of lectures delivered by 
able professors; attend during a sufficient time to clinical instruction, 
and are not licensed to practise before giving evidence, in several 
examinations, of their possessing the necessary qualifications and in- 
struction; while the searchers receive, as has been already stated, no 
theoretical or practical instruction, and are therefore unable to obtain 
their experience otherwise than by attendance on the dead. 

Having disposed of this part of our subject, we proceed to lay be- 
fore our readers some facts relative to the mortality of England and 
its immense metropolis, to the principal diseases by which this mor- 
tality has been, and continues to be caused, and to the variations 
manifested at different periods in respect to the prevalence of those 



156 Medical Statistics. 

maladies. But in order to convey a more correct and satisfactory 
view of these several subjects, it will be necessary to present a state- 
ment of the population of the metropolis and of the whole country at 
various periods. On this head, the information contained in Mr. 
Graunt's work cannot, we fear, be safely relied upon; inasmuch, as 
his calculations do not appear to be founded upon official data. He 
informs us, that in his time, some of the good people of the city — of 
great experience too, had a very exalted opinion of the immense po- 
pulation of the metropolis, talking seldom "under millions of people 
to be in London," all of which, Mr. Graunt confesses, he was apt to 
believe " until, on a certain day, one of reputation was upon occasion 
asserting, that there was in the year 1661, two millions of people 
more than anno 1625, before the great plague, which would have 
made the whole number then in London to be six or seven millions." 
As this number appeared to the shrewed author to be extraordinarily 
large, he was induced to undertake a computation of the inhabitants. 
By comparing the number ot deaths reported annually; the number of 
births, abortions, &c. he concluded that the eminent individual who 
had advanced the above opinion, had gone very far beyond the mark, 
and that in 1661, the population of London — of the ninety-seven pa- 
rishes within the walls, and eighteen out parishes, did not amount to 
more than 384,000. But this estimate, low as it may seem in com- 
parison to six millions, appears nevertheless to be too high, for Mr. 
Marshall states, that according to an enumeration, which seems to 
have been carefully made in 1631, the total population of the whole 
city of London, both within and without the walls, including four 
parishes in Surrey, (which, since 1750, have been included among 
out parishes,) making in all, independently of the parishes of the city 
proper, the same number of out parishes as mentioned by Mr. Graunt, 
amounted to 130,178; — a number, much too small to allow us to 
regard the estimate of Mr. G. as accurate, since the interval between 
the two periods was only thirty years, and the population could not, in 
so short a time, have trippled in extent. In another estimate in which 
are included the ninety-seven parishes within the walls, and thirty- 
three out parishes, Mr. Graunt supposes the number of inhabitants to 
have amounted to 460,000 in all. Here he appears to us to have 
erred on the other side, for in 1700, only thirty -nine years after the 
period mentioned by him, the out parishes alone, exclusive of those 
composing the city of London within and without the walls, and of 
Westminster, contained 326,000 souls, and the population of the 
whole of that part of the metropolis within the bills of mortality 
amounted to nearly 200,000 more than the number stated by him. 



Medica I Statistics. 157 

Be this, however, as it may, Mr. Marshall has furnished at page 
12 of his admirable work, a statement showing the progressive increase 
of the population in each of the districts composing the metropolis at 
five different epochs from 1700 to 1821 inclusive. From this state- 
ment, it is found, that the population of that part of. the metropolis 
situated within the bills of mortality, viz. 1st. The city of London 
within the walls, including ninety-seven parishes. 2d. The city of 
London without the walls, including seventeen. 3d. The city and 
liberties of Westminster, including ten. 4th. The out parishes 
within the bills, including twenty-nine parishes, amounted in 1700 to 
665,200; in 1750, to 653,900; in 1801 to 777,000; in 1811 to 888,000; 
in 1821 to 1,050,500 inhabitants. 

If to these numbers we add that of the inhabitants of the out pa- 
rishes not within the bills, which amounted in the first period to 
9,150; in the second to 22,350; in the third to 123,000; in the fourth 
to 162,000, and in the last to 224,300; together with, (in the three 
last periods,) the remainder of Middlesex within the range of the 
metropolitan police, and the other parishes in Surrey, some in Kent, 
and the Becontree Hundred Essex, all of which are, in like manner, 
within the same range, we shall find that the total population of the 
metropolis of the British Empire was as follows: — in 1700, 674,350; 
in 1750, 676,250; in 1801, 1,097,896; in 1811, 1,304,359; in 1821, 
1,574,689. 

In these statements are included the seamen, strangers, &c. daily 
arriving in London, and who in 1821 amounted to 47,210. It will 
be found from the documents furnished by Mr. Marshall and by Mr. 
Hickman in the Population Returns, that the number of inhabitants 
within the bills .of mortality rather decreased than increased from 
1700 to 1750; and that this effect was particularly striking from 
1700 to 1811 in the part of London known under the appellation of 
the City. The number in 1700 was 139,300, while in 1750 it did 
not exceed 87,000, and in 1811 it was reduced to 57,700, beyond 
which it has hardly risen since. The same documents will show, that 
the increase has principally taken place in the out parishes, both 
within and without the bills; for in the former the population, which 
in 1700 did not exceed 326,900, amounted in 1811 to 730,700, while 
the number in the parishes without the bills increased in one hundred 
and twenty years from 9,150 to 224,300. In explanation of the 
first of these facts, it is mentioned that at the former period, four 
parishes in Surrey— St. George, St. Olaves, St. Saviours, and St. 
Thomas, which, in 1750, and subsequently thereto, were included 



158 Medical Statistics. 

under the head of out parishes within the bills of mortality, were in 
all probability included in the city within the walls; that in 1811 and 
1821, the precincts of White Friars, St. Botolph, &c. containing to- 
gether 1 1,741 inhabitants, were placed without the walls, but were, 
as late as 1801 included in the city within the walls; that the Bank 
of England, the Mansion House, Blackfriars Bridge, the East India 
House, and other public buildings, which were all erected since 1700, 
occasioned considerable demolition; that there exists a progressive 
tendency of inclination on the part of the inhabitants of the city for 
country residence; and finally, that a large number of houses con- 
tiguous to public buildings have been transformed into counting- 
houses. As regards the second fact — the much greater increase in 
the population of the out parishes, it will be sufficient to remark, that 
many among these are located in those parts of the metropolis within 
the range of influence of the shipping business, which has more than 
doubled itself since 1810; while the others are the seat of a manufac- 
turing industry, whose products are spread in every part of the world, 
and which necessarily attracts and tends to concentrate together a 
larger concourse of individuals than the city both within and without 
the walls, the commerce of which is limited to one of simple con- 
sumption.* 

With respect to the population of London at a later. period, Mr. 
Marshall furnishes us with no positive information, — his work having 
probably been prepared for publication too early in 1832, to enable 
him to make use of the official statements contained in the population 
returns laid before parliament the year before, and which were publish- 
ed about the same time as his own volume. He only presents us there- 
fore with an estimate of the population of the metropolis for 1831, 
which somewhat exceeds that reported in the official documents, in- 
cluding, as it does, the probable number of seamen and strangers, — 
a class of individuals that appear to be excluded from the other enu- 
meration. According to the latter, the whole fixed population of the 
metropolis in 1831, including that of the adjacent parishes not within 

* At page 25 of the population returns of 1831, we find a statement of the 
population of London in 1801, 1811, 1821, and 1831. This statement in regard 
to the three- first periods, differs somewhat from that given by Mr. Marshall, 
both as regards the aggregate population of the whole city, and the number in 
each district composing the latter — the numbers mentioned by Mr. M. being in 
each case larger than those mentioned in the "Returns." But Mr. Marshall 
evidently includes in his enumerations the seamen, strangers, &c. while this is 
not the case in the official documents. 



Medical Statistics. 159 

the bills, amounted to 1,474,069, and exclusive of these to 1,180,502. 
The distribution of this amount in the different districts, was as fol- 
lows: — 

London within the Walls --.--... 57,695 

London without the walls --...-. 67,878 

Southwark, borough ---.».. 91,501 

Westminster city 202,080 

Out parishes within the bills of mortality - - - 761,348 

Adjacent parishes not within the bills .... 293,565 

Total 1,474,069 

Mr. Rickman, the author of the returns from which the foregoing 
statement is borrowed, remarks, that objections may undoubtedly be 
made to the propriety of the limits of the metropolis herein assumed, 
and that it is, therefore, convenient to add, that the total population 
of all the parishes, that of Woolwick excepted, whose churches are 
situated within eight English miles rectilinear from St. Paul's Cathe- 
dral, amounted to 1,031,500 in 1801; to 1,220,200 in 1811; to 
1,481,500 in 1821, and in 1831 to 1,776,556; a twenty-fifth part be- 
ing added in each of these instances as a moderate allowance for sea- 
men, soldiers, and transitory population. 

As regards the population of the whole of England and Wales, we 
find that it amounted in 1781 to 7,953,000; in 1791 to 8,675,300; in 
1801 to 8,872,982; in 1811 to 10,163,676; in 1821 to 11,978,875; 
and in 1831 to 13,894,574. Scotland in each of those ten year pe- 
riods had a population, in 1781 of 1,470,000; in 1791 of 1,500,000; 
in 1801 of 1,599,068; in 1811 of 1,805,688; in 1821 of 2,093,456; 
in 1831 of 2,365,807. The population of the whole of Great Britain, 
including the army and navy, &c. which are omitted in the above 
statements, was in 1781, 9,673,000; in 1791, 10,165,000; in 1801, 
10,942,646; in 1811, 12,609,864; in 1821, 14,391,631; and in 1831, 
16,537,398. 

Before passing to the subject of the relative proportion of the sexes, 
which is next to occupy our attention, it is necessary to remark, that 
the information possessed respecting births, as well as marriages 
and deaths, is only obtained from the parish registers, the origin of 
which dates from the establishment of the Church of England, and 
which are left entirely in the hands of the clergy of this church. 
Owing to this circumstance the dissenters keep no registers, or at 
least furnish no reports; and as others, particularly the poor, conceal 
as far as they can the births, marriages, and deaths which occur in 
their families, in order to avoid paying the tax levied on all records. 



1 60 Medical Statistics, 

it results that the reports issued by the parish clerks* or otherwise 
obtained bj government, are not as complete and accurate as might be 
desired. In this respect France has greatly the advantage over Eng- 
land, because there the duty of registering is exclusively confided to 
the civil authorities, to whom the various denominations of individuals 
are strictly enjoined to report all cases of births, marriages, and 
deaths occurring among them; and whose documents must in conse- 
quence be infinitely more complete than those that might be obtained 
from the registers of the catholic or other clergies. Hence in speak- 
ing of the births and deaths in England, some allowance must be 
made for the number of those which are not registered in the parishes, 
and which consequently are not reported to government. This im- 
perfection, however, will readily be understood to affect the question 
of the full number of births, &c. and not of the relative proportion 
of the sexes, because in the amount unreported the latter must bear 
the same proportion to each other as would be found to be the 
case in an equal number reported. The following statements are, 
therefore, only founded on the returns obtained from the parish 
registers, and not on the real number of births, marriages, and 
deaths occurring in England. From these returns it will be found 
that in Great Britain male births exceed those of the female sex. 
Thus, in the ten years included between 1801 and 1811, the regis- 
tered births in all England amounted to 2,730,965, and in those be- 
tween 1811 and 1821, to 3,100,261. In the first period the excess of 
boys over girls was 51,984. In the second, 66,035. In each of these 
ten yearly periods the excess among the boys was constant in each se- 
parate county. In Wales during the first period there was a majority of 
14,939 boys, and in the second period a majority of 5,992. Mr. Mar- 
shall presents a very full and complete table, showing the total num- 
ber of marriages, baptisms, and burials in all England and Wales at 
each of nine ten yearly periods, from 1700 to 1780, and in each of 
the forty years, 1781 to 1820. From this table it will be perceived, that 
the boys at birth have invariably exceeded the females in each of the 
specified years. As may probably be known to our readers, this ex- 
cess of male over female births, is not peculiar to England^ for it is 
found to obtain all over the world. But though this is shown to be 
the case, the excess is not exactly the same every where. By a care- 
ful calculation of the births in England in 1801-11-21, it has been 
found that the proportion of boys to girls was as 104 T 7 ^ to 100. In 
France, from 1770 to 1774, inclusive, the proportion was lOGy 7 ^- boys 
to 100 females, and from 1817 to 1827, inclusive, as 106^ to 100. 
From 1817 to 1829, they were as 16 to 15. In Sweden the propur- 



Medical Statistics. 161 

tion of male to female births, was, from 177 5 to 1794 as 103^ to 
100; and from 1816 to 1825, as 104^ to 100. In Wurtemberg the 
boys have on several occasions exceeded the girls by 7 per cent.; and 
in Russia, the excess from 1812 to 1829, amounted to 8 T 9 ^. per cent. 
From these facts, and others that could be easily mentioned, it fol- 
lows, that with the exception of Sweden, England presents the smallest 
excesg of male over female births. 

As we find in the works before us no account of the proportion of 
the sexes among illegitimate children, it is impossible to ascertain 
whether in England the excess of males over females is more limit- 
ed in that class than among the legitimates, as is found to be the case 
in every part of the continent of Europe. 

As regards London in particular,' it will be found, on examining 
Mr. Marshall's tables, that in the various periods we have mentioned, 
from 1700 to 1820, the excess of births among males has also been 
strong, though not as constantly so in each separate year, as we have 
seen it to be the case in the country generally. In the forty-nine 
years specified separately, the female births presented an excess six- 
teen times; and in the twenty years, from 1801 to 1821, the excess of 
male over female births, in the four divisions of the metropolis within 
the bills and in the out parishes, not within the latter, amounted to lit- 
tle more than 2,600. During a period of 136 years, 1656 — 1776, 
and 1786 — 1810, the male births in London exceeded the female by 

^tW P er cen t« 

In this respect London had then the advantage over Paris. Since 
that period, however, it appears to have lost it, for during the twelve 
years, 1819-29, the male births at Paris exceeded the female by 3 T 5 ^ 
per cent. ; and in 1828 the former were to the latter as 24 to 23; while 
the proportion in London in the twenty years we have mentioned, 
was as about 99 to 98. In Philadelphia, the excess of males within 
the ten years, 1821-1830, was greater than in either of those two 
cities — Varying in each of those years from 3.6 to 10.5 per cent, and 
giving an average of more than 7 per cent. 

The next point to be ascertained is the proportion of the sexes at all 
periods of life. According to Mr. Graunt, the number of males, in his 
time, was one-thirteenth part larger than that of females in London, 
and one-fourteenth part in the country. This information is interest- 
ing, as it afifords an example of the change that has taken place on the 
subject in question since the middle of the seventeenth century; it being 
a fact placed beyond the possibility of doubt, that for many years past 
the number of females in London, and England generally, has ex- 
ceeded considerably that of males. In the year 1811, the females in 

No. XXV.— Nov. 1833. 15 



162 Medical Statistics. 

London amounted to 690,683, while the males did not exceed 
586,444. In the year 1821, the number of females in all the districts 
within the bills of mortality, exceeded that of males by 56,240; while 
in the entire metropolis on a population of 1,574,689, the number of 
females exceeded that of males by 103,879. With respect to the 
proportion in 1831, we find in the Population Returns of that year, 
that in all the districts within the bills of mortality, and in the adja- 
cent parishes not within those bills, on a population of 1,474,069, 
the females amounted to 789,628, and the males to 684,441. The 
same returns not only show, that in all the large cities of England, 
Wales, and Scotland, the females exceed the males in number, but 
that a like result obtains throughout Great Britain generally. In 
1801, the excess of females in England and Wales amounted to 
382,754; in 1821, it amounted to 416,098; and in 1831, on a popu- 
lation of 16,537,398, including the army and navy lists, the number 
of females amounted to 8,375,780, and that of males to 8,161,618. 
From this statement it will immediately be seen, that though the fe- 
male population throughout the whole country is larger than the male, 
the proportion of the sexes is not the same in the country generally 
as it is in the city of London taken separately; the number of males 
being proportionally larger, and the majority of females consequently 
smaller in the former than in the latter. Thus, in 1811, the majority 
of the females in London was a little more than one-twelfth; while in 
the entire country it was only a little more than one thirty-fourth 
part of the whole population. In 1831 the excess in London was one- 
fourteenth, and that in the whole country only one seventy-seventh 
part of the population; the proportion being for London, 100 females 
to 86.7 males; and for the whole country, 100 females to 97.44 males. 
The fact becomes still more striking if we examine the relative pro- 
portion of the sexes in the whole country exclusive of the population 
of London, for while the majority of females in that city rose, in 1 831, 
to one-fourteenth of the population, the majority in the rest of Great 
Britain constituted the one hundred and eightieth part of the 
population. Taking each portion of Great Britain separately, 
we find that the excess of females in England constitutes a 
little more than one thirty-eighth part; in Wales a little more than 
one forty-seventh part; and in Scotland, between a seventeenth 
and eighteenth part of the population. This excess of females 
though found to obtain in Belgium, Sweden, does not do so in all 
other countries. In France the male population at present exceeds the 
female. Our readers are probably aware that in this country taken in 
the aggregate the same circumstance occurs — whether we have refer- 



Medical Statistics. 163 

ence to the black or white portions of the people; and we have the 
authority of Humboldt for the fact, that it also occurs in Mexico. 
But while such is the truth in reference to the proportion of the sexes 
in the whole country, it will be found that in the large cities of 
France, of this country, of Mexico, and other places, the females ex- 
ceed the males yery nearly in the same ratio as they do in London. 
But it is not only found, that females exceed males in number in Great 
Britain, but that they are gaining ground; a circumstance directly op- 
posed to what takes place in France. In the latter country, during 
a period of thirteen years, 1817-29, the total increase of the popula- 
tion amounted to T i y annually. To this increase the males contri- 
buted at the rate of ^ T , and the females at the rate of yjy. In Great 
Britain, on the contrary, the annual rate of increase during a period 
of thirty years, 1801-31, as shown by the returns of those periods, 
was -g-gVTT:* To this the males contributed T¥ -J-.-92> an( ^ tne females, 
Tri-06- 1° °ther words, the females in 1831 were to the females in 
1801, as 152.5 to 100; and the males in the same periods, as 149.75 
to 100. If we make our calculation on the increase of the population, 
as shown by the difference between the registered births and deaths 
in England and Wales, we find, that in a period often years, 1811- 
20, the males contributed {T ^ mT ^, and the females, Tnhrrs' results 
differing but little from those we have just mentioned. In the same 
period the annual increase was one sixty-sixth instead of one eighty- 
ninth; the difference being accounted for by the emigration into Eng- 
land from Ireland and elsewhere, and by the unreported births. 

To what we have said in reference to the proportion of the sexes, 
it may be added, that although the females exceed the males in Eng- 
land, they do not do so at all periods of life; for between birth and 
the age of thirty, and between forty and fifty, the males exceed the 
females. Nor is this irregularity in the proportion observed only in 
England. It is found to take place in France, and in other parts of 
Europe. In the United States white males exceed the females 
of the same colour throughout the country; but the contrary is found 
to be the case among white individuals between fifteen and twenty 
and seventy and one hundred; as well as among the slaves between 
the age of twenty-four and thirty -six. 

It may be interesting to offer a few remarks on the subject of the 
relative number of individuals of each sex, at various periods of life, in 
England. Taking the whole country in the aggregate, it is found, that in 
every 20,000 inhabitants, there are under the age of five years, 2,982; 
between five and ten, 3, 611; between twenty and thirty, 3, 154; between 
thirty and forty, 2,365; between forty and fifty, 1,873; and between 



164 Medic a I Statistics. 

fifty and sixty, 1,318. On comparing this statement with the results 
obtained in France, we find, that the number of individuals between 
twenty and thirty are nearly equal in both countries. Among those 
between thirty and forty, forty and fifty, and fifty and sixty, France fur- 
nishes a larger number. The same may indeed be said of individuals 
between sixty and eighty; but beyond that age the advantage is de- 
cidedly in favour of England. 

As regards the comparative number of individuals at various pe- 
riods of life in London and Paris, we find that in 10,000 in each of 
those cities, London presents a larger number between birth and 
the age of fifteen, as well as between twenty and forty, and above 
one hundred; but that the number of individuals between the ages 
of fifteen and twenty, and forty and one hundred, is more consider- 
able in Paris than in the former.* 

By comparing these facts with Mr. Graunt's statement to which we 
have referred, it will be perceived, that supposing the latter to be cor- 
rect, things have greatly changed since the middle of the seventeenth 
century. While contending for the greater number of males than fe- 
males, not only in London, but in the country at large, Mr. G. re- 
marks, that the proportion of the sexes may be reversed in some 
places without affecting the result in the country generally. This is 
found to be the case in Great Britain at the present time; for though 
an examination of Mr. Marshall's tables, and of the Population Re- 

* The following- table will show the probable number of individuals in Great 
Britain engaged in and dependent on various branches of occupations, in the 
year 1831:— 

Agricultural occupiers -----,- 1,500,000 

Agricultural labourers ...--. 4,800,000 

Mining labourers - 600,000 

Millers, bakers, butchers - - - - - - 900,000 

Artificers, builders, &c. ----- - 650,000 

Manufacturers -------- 2,400,000 

Tailors, shoemakers, and hatters - 1,080,000 

Shopkeepers • - 2,100,000 

Seamen and soldiers ------- 831,000 

Clerical, legal and medical - 450,000 

Disabled paupers ------- 110,000 

Proprietors, annuitants -.----■ 1,116,398 

Total - 16,537,398 

A comparison of the probable proportions in 1821 and 1831, shows that while 
the labourers tend progressively to increase, the number of agricultural em- 
ployers remains stationary. 



Medical Statistics. 165 

turns before us, show that for a considerable time back, the females 
have exceeded the males in the separate countries, yet a few excep- 
tions to this rule are met with. In the year 1811, the counties 
of Stafford and Cambridge contained a few more males than females. 
The same circumstance was noticed in the year 1831, in seven 
counties of England, two of Wales, and one of Scotland. A refer- 
ence to the Population Returns will also show, that in the year 1831, 
out of six hundred and forty-seven towns, cities or hundreds in Eng- 
land, two hundred and twenty-four presented an excess of males over 
females; and that out of one hundred places of the same description 
in Wales, and thirty-seven in Scotland, there were twenty-five in 
the former, and two in the latter in which a similar result obtained. 

An examination of the facts already stated, and a reference to the 
Returns, will show that the population of London increased during the 
ten years 1801-11, 17 per cent, from 1811 to 1821, 21 per cent, and 
from the ktter year to 1831, 20 per cent. ; but that the various districts 
experienced fluctuations in the movements of their population at the 
several periods we have mentioned. Thus in the first period, London 
within the walls decreased thirty-five per cent, and London without 
the walls twenty-five per cent. In the second period they increased 
but slightly; the former at the rate of one per cent, and the other of 
six per cent. The increase of the borough of Southwark in those 
periods was 7,< 19, 7 per cent. That of Westminster, 2, 12 and 11 
per cent. — of the parishes within the bills 37, 24, 23 per cent, and of 
the adjacent parishes not within the bills, 32, 38 and 36 per cent. 

The population of England experienced an increase, from 1801 to 
1811-, of 14| per cent, from 1811 to 1821 an increase of \7\ per 
cent, and from 1821 to 1831 one of 16 per cent. The increase of 
Wales in the same period was 13, 17 k and 12 per cent, and that of 
Scotland 14, 1 6 and 13 per cent, and finally, that of the whole of Great 
Britain 15J, 14, 15 per cent.* The increase of the metropolis from 
the beginning of the last century to 1831, was 222 per cent, while 
that of the population of the whole of England within the same period 
was 154 per cent, that of Wales 117 per cent, that of Scotland 87 
per cent, and finally that of the whole of Great Britain 144 per centt 

* In the same periods the increase of the female sex, (by adverting- to which 
a more accurate knowledge of the increase of population may be obtained, as 
we thereby virtually omit throughout the calculation, such of the army, navy, 
and merchant seamen as are not in Great Britain,) was 14.15; 15.71; 15.45 per 
cent. 

f The ratio of increase in each county taken separately, is found to have 
differed very materially. In Lancaster from 1700 to 1831, it amounted to 800 

15* 



166 Medica I Statistics. 

Captain Graunt enters into a long and curious calculation with a 
view of ascertaining not only the probable population of London in 
his time; but also the number of years that that population would 
require to double itself " by the ordinary proportion of breeding and 
dying." The results to which he arrives are, that the breeders whose 
numbers he estimated at 24,000 pairs, would require eight years to 
double themselves in plague seasons, and seven years in ordinary 
times. 

" Wherefore since there be 24,000 pair of breeders, that is one-eighth of the 
whole, it follows that in eight times eight years, the whole people of the city 
shall double without the access of foreigners." 

Elsewhere he makes out the accession with the aid of foreigners, 
(by which name he understands people from the country,) to be from 
two to five in fifty-six years. We suspect, however, that the worthy 
gentleman was far from the truth on this point; because, judging from 
the increase which took place from 1631 to 1700, and from 1750 to 1801 
the doubling of the population would have required in the first period 
about one hundred and fifteen years, and in the second about one hun- 
dred and fifty-one years. On the other hand, basing our calculation 
upon the progress of increase during the last thirty years through- 
out the entire metropolis, we find that the doubling of the population 
would require only between forty-two and forty-three years. As re- 
gards the doubling in the whole of Great Britain, it will be found on 
basing our calculation upon the increase that has taken place during 
the period above mentioned, that the time required will be 54-f^ 
years. In England and Wales alone 53 years, and in Scotland 62? 
years. The females alone double their number in a little more than 
fifty-seven years. 

It is a fact, the truth of which must be recognised by every one 

per cent.; in York West Riding 417; while in Rultand it was only 17, and in 
Northampton, 50. The ratio of increase in the manufacturing and mining dis- 
tricts in the three ten year periods 1801-31, was 18 J, 20^, 22£, and from 1700 
to 1831, 295 per cent. In the agricultural counties 9f, 15J and 10-|, and 
from 1700 to 1831, 84 per cent. In the metropolitan counties 16J, 18f, 15^, 
and from 1700 to 1831, 147 per cent. The above statement as Mr. Marshall very 
properly remarks, shows the change that has taken place in the relative im_ 
portance of the English counties since 1700, in a more perspicuous point of 
view than any in which it has heretofore been exhibited; the increase is seen 
to predominate greatly in the manufacturing and mining districts, while the 
statement of the population of the principal towns of England and Wales, shows 
that the increase of the agricultural counties is principally in the towns; so that 
the rural population of England, as in the agriculturing counties of Scotland, 
appears not materially, if at all, to have increased since 1700. 



Medical Statistics. 167 

who has paid some attention to medical statistics, that the move- 
ment of population is every where greatly modified by wide-spread- 
ing maladies, independently of the differences arising from the 
increased mortality occasioned by the prevailing disease. This 
modification is observed whether the malady giving rise to the ex- 
cess of mortality, be endemic or of frequent occurrence; or whether 
its visitations occur at long intervals. The modification to which 
we allude, arises principally from the greater rapidity with which 
the population is renewed in places usually unhealthy and every- 
where subsequently to times of unusual mortality. The first is ob- 
served, for example, in marshy districts, where although the number 
of deaths proportionally to the population may be greater than in 
other situations, and the mean duration of life shorter, the population 
does not, as it might have been anticipated to do, diminish; — marriages 
taking place earlier in life, and the number of births being thereby 
as well as by a smaller number of checks, and perhaps a greater pro- 
creative force, considerably increased in a given extent of territory 
and proportionally to the number of inhabitants. Belgium offers us 
many facts in corroboration of this statement, for wherever in that 
country the mortality proves larger, the number of births will also 
be found to be greater. So often indeed has this been observed, that 
by many writers on political economy it has been regarded in the 
light of an axiom. 

Whenever also an epidemic disease of a severe and highly fatal 
character prevails and carries off a great number of inhabitants, 
or whenever a country has suffered from scarcity of food, or from the 
scourge of war, the mortality thus occasioned, is succeeded, almost 
immediately after, by an extraordinarily large number of marriages 
and births. To such a degree, does this sometimes occur, that 
many couples who, though cohabiting together, had long ceased to 
have children, reacquire the procrcative faculty. Finally, severe and 
fatal epidemics are generally succeeded by periods of uncommon 
healthfulness, when the proportion of mortality to births diminishes 
considerably. Whether the causes of this circumstance are to be 
sought for in the fact, that the distemper has carried off the declining 
and worn out constitutions, and that the previous mortality has af- 
forded more room and a greater plenty of food to the survivors, there- 
by promoting, as Dr. Short and Mr. Malthus have conjectured, a 
meliorated condition of the lower classes of the population; or whether 
finally, it is in some measure the result of the afflux of people 
from other parts, are so many points we shall not undertake to dis- 
cuss at present. All we need insist upon here is, that whatever be 



168 Medica I Statistics. 

its real cause, the fact to which we allude has been verified over and 
over again, and is attested by the most undoubted authorities. It was 
noticed in Holland and Belgium in the years 1 8 1 5-1 6-17-1 8-20, as well 
as in some of the French departments, after the invasions of the allies 
in 1814-15, and after the great scarcity which occurred in 1817; and 
every one who has read Malthus, must recollect the statement quoted 
by that author from Sussmilch, which shows the movement of the 
population of Prussia and Lithuania before, during and after the great 
plague which ravaged those countries in 1709-10, and establishes the 
fact in question in the most satisfactory manner.* An equally striking 
example of it is furnished by the history of the plague at Marseilles in 
the year 1720; for although it is shown, by the records of all the 
parishes, that the mortality on that occasion was very considerable, — 
amounting to nearly 40,000, the population of that city was as large 
five years after as it had been previous to the commencement of the 
pestilence. 

Nor is it less certain that the various circumstances we have here 
mentioned, are confirmed by facts observed in England. On inquiry, it 
will be found that in those countries where the number of deaths is 
proportionally large, the number of births is so also to a remarkable 
degree. A similar result has been observed in London, as the following 
statement from Mr. Graunt's work, which is fully borne out by a 
series of tables contained in Mr. Marshall's volume, will show. 

"The next observations we shall offer, is the time wherein the city hath 
been repeopled after a great plague, which we affirm to be by the second year. 
For in 1627, the christening's, (which are our standard in this case,) were 8,408, 
which in 1624 next preceding- the plague year, 1625, (that had swept away 
above 54,000,) were but 8,299, and the christenings of 1626, (which were but 
6,701,) amounted in one year to the said 8,408. Now, the cause hereof, for as 
much as it cannot be a supply by procreations; ergo it must be by new affluxes 
to London out of the country. We might fortify this assertion by showing that 
before the plague year, 1603, the christenings were about 6,000, which were in 
that very year reduced to 4,789, but crept up the next year, 1604, to 5,458; 
recovering their former ordinary proportions in 1605, of 6,504, about which 
proportion it stood till the year 1610." 

* During the years 1709-10, when the plague occurred in Prussia and 
Lithuania, the mortality amounted to 198,693. This reduced the population 
to 322,267. But notwithstanding this very great diminution in the number of in- 
habitants, the marriages in the next year were nearly double their average 
number during the six years preceding. In the year previous to the plague, 
the number of marriages was 6,082 — that of births 26,896. In 1711, the former 
amounted to 12,028, and the births 32,522. The marriages were therefore in 
fie ratio of one twenty-sixth, and the births of one-tenth of the remainder of 
the population. 



Medical Statistics. 169 

Graunt here attributes, perhaps, more influence to the aiflux of 
people from the country, and less to the augmentation in the number 
of marriages and procreative power than others would do, considering 
as he did, that a given number of births supposes always a fixed pro- 
portional number of inhabitants. But whether he be right or not in his 
conjectures, the facts he states in relation to the city of London, show 
that the latter affords the confirmation of the circumstances alluded 
to : for either one or the other of two things must be admitted to have oc- 
curred — that a reduced population produced a comparatively larger 
number of births, or that the city was, as Mr. Graunt affirms, repeopled 
by emigrations in a very short space of time. The same result will 
be found to have obtained in England at a much later period. Mr. M. 
furnishes at page 27, a statement of the number of baptisms and 
burials in every county of England and Wales in each of the seven 
years, 1798-1804, a period considered as one of the most remarkable 
in the history of Great Britain, when the whole world either openly or 
insidiously were in array against it. Nevertheless, after the first effects 
of the war had subsided, England presented an unprecedented increase 
of population — the excess of baptisms over burials in 1798, consi- 
derably exceeding the like excess in any former year. After the 
peace of Amiens, the same effect was produced, and the general 
peace in 1815 was also followed by an unprecedented excess of bap- 
tisms. 

The population of London increases in great measure by emigra- 
tions from the country and from foreign parts. This will be imme- 
diately seen by a reference to the statements furnished by Mr. Mar- 
shall. They show that from the year 1604 to the present century, 
the number of christenings, which furnish the only clue to a know- 
ledge of the number of births in the metropolis and throughout Eng- 
land, was almost always below that of burials, sometimes to the 
amount of 7, and even 8,000. In a very few instances only were 
they equal to the latter, and in still fewer superior. It is very 
clear, therefore, that the increase of the population must have 
entirely depended, during that time, on the afflux of people 
from the country or elsewhere. From 1802 to 1830, the pro- 
portion of the christenings to deaths has, with the exception of 
one year, been constantly the reverse of what it was prior to 
that period; the excess of births over burials being in some years 
as great as 6,000, (the whole number being 30,000, and that of 
deaths 24,000.) Yet, notwithstanding this change, the excess of 
births since 1802, will not serve to account alone for the increase of 
the population, because between 1801 and 1821, the excess amounted 



170 Medical Statistics. 

to about 72,000, while the augmentation in the number of inhabitants 
was about 375,000. Nor is it less certain, that the population of 
England and Wales generally, also increases in another way than by 
the excess of births over burials. One of the tables contained in Mr. 
M.'s work shows, that from 1700 to 1820, the increase in the whole 
country amounted to 6,744,200. From 1780 to 1820, the excess of 
births over deaths amounted to 3,456,489. Now, the increase of 
population from 1700 to 1780, amounted to 2,356,552. These two 
sums — the excess of births from 1780 to 1820, and the increase 
from 1700 to 1780, added together, give 5,813,041. By deducting 
this last sum from the total increase of the population, 6,744,200, 
we have a balance left of 931,267, which, supposing no omissions 
to have been made in the returns, constitutes the increase of popula- 
tion beyond the excess of births, and is necessarily the result of emi- 
grations from Ireland and other parts. 

But these tables are not only interesting to us from their establish- 
ing the fact, that the population of London and of England generally, 
increases by emigration from without, but also from pointing out 
other facts relating to the proportional number of births to burials 
in different parts of the country, and which we shall have occasion 
to notice in the course of this article. 

In England and Wales the average number of marriages, (basing 
our calculation upon the returns of twenty years, 1801-21,) amounts 
to 87,076 annually, and in England alone to 82,424. The average 
number in each of the ten years, ending with 1790, was 67,253.5$ in 
each year from that period to 1800, 72,258.3; to 1810, 83,209.1; to 
1820, 91,042.6. In the ten years from 1801 to 1811, the proportion of 
marriages to every 100 of the population of England and Wales, was 
9.4. In England alone, 9.47. From 1811 to 1821, the proportion in both 
countries combined was 7. 67; in England alone, 9.06. In each of the 
ten years from 1790 to 1800, the number in 1,000 of the population of 
England and Wales was 81; in each of those from 1800 to 1810, 82; 
and from 1810 to 1820, 76. Finally, in the Returns of 1831, we find a 
table exhibiting the proportion of marriages to the population in a 
different and more simple manner. From this table we learn, that in 
the live years from 1796 to 1800, there took place in England one 
marriage in every 123; from 1806 to 1810, one in every 122; from 
1816 to 1820, one in every 127, and from 1826 to 1830, one in every 
129 of the population of those respective periods. But while such 
was the proportion in all England, it varied considerably in some of 
the counties taken separately. In the ten years ending with 1800, 
the proportion to every thousand of the population was in Middlesex, 



Medical Statistics. 



171 



106; in Hereford, 58. In the ten years ending with 1810, Middlesex 
presented a proportion, to the same number of the population, of 106; 
Hereford of 61; and from 1810 to 1820, Middlesex gave 96; Here- 
ford 57, and Flint in Wales 55. The same county in the various 
periods we have mentioned gave different results, Middlesex present- 
ing 106, 106, 96; Lancaster 83, 92, 81; York West Riding 74, 95, 80; 
Glamorgan, (Wales,) 56, 82, 64. Both these facts will be further 
illustrated by the following statement, extracted from the tables al- 
ready quoted from the Population Returns of 1831. 



1796—1800. 


1806-10. 


1816-20. 


1826-30. 


Bedford - - - - 1 in 113 

Bucks 148 

Cambridge - - - - 118 
Hereford ----- 183 

Middlesex 95 

Rutland 131 

Surrey 134 


131 

144 
130 
144 
94 
161 
129 


124 
140 
117 
171 
101 
142 
139 


129 
149 
124 
149 
102 
138 
129 



On comparing these proportions with those observed in France and 
the Netherlands, it will be perceived that the number of marriages in 
England is greater than in those two countries; for from the official 
documents before us, we find that in France the average number in 
each of the years, 1817-29, amounted to one in 132.4 of the popula- 
tion, and that the same proportion obtains at present in the Netherlands. 
In the department of the Seine, however, the proportion agreeably 
to the statements published in 1827, amounted to one in 109; but 
in the department of La Manche, it did not exceed one in 198. In 
Paris, the number in 1820 was one in 123, and in 1827, one in 131, 
while in London in 1820, the proportion, according to the parish re- 
gisters, was one in about 100. 

The number of baptisms in all England and Wales in each of the 
four ten yearly periods ending with 1790, 1800, 1810, 1820, amounted 
to 2,324,298; 2,538,434; 3,027,526; 3,585,727, giving an average 
in each year of the first period of 232,449.8, of the second period of 
253,843.4; of the third period of 302,752.5, and of the fourth of 
358,572.7. The ratio to every 100 marriages in each of the ten 
years ending with 1790, 1800, 1810, and 1820, was 348, 351, 363, 
380. The ratio to a marriage in the ten years, 1801-10, was 3.63; 
in the ten years, 1811-20, 3.8. 

Finally, the proportion of registered baptisms to the population in 
England was in the five years 1796 — 1800, one in thirty-six; 1806 — 
1810, one in thirty-four; 1816—20, one in thirty-five; and 1826—1830, 



172 



Medical Statistics. 



one in thirty-seven. The proportion of baptisms in the different counties 
of England and Wales, like that of marriages, differed very consi- 
derably in the various periods we have mentioned. In the ten years 
ending in 1790, the ratio in Berks was 422 to every 100 marriages; 
that in Hertford, 427; Denbigh, (W.) 428; Montgomery, (W.) 429; 
while in Middlesex, where the proportion of marriages was greatest, the 
ratio was only 9,55; and in Carmarthen, (W.) 271. In the next pe- 
riod ending with 1800, the ratio in Middlesex was still lower than it 
had been in the preceding, being only 244; while that in Montgo- 
mery, (W.) was 449; and that in Flint 500. In the third period 
ending with 1810, the ratio in Middlesex was 238; and*those in Flint 
490; Rutland 457; and Hertford 478. In the fourth period ending 
with 1820, the ratio in Middlesex was 280; in Hertford 519; and in 
Flint 560. The ratio is found to have increased in some counties at 
each successive period; though in some cases the reverse occurred. 

The ratio of births to the population in the separate counties as 
well as the diversity of the proportion in each of these, and the fre- 
quent examples of progressive improvement in the number of births 
in the same county, is exemplified in a table contained in the Popu- 
lation Returns, from which we offer a short extract. 



1796—1800. 


1806-1810. 


1816-1820. 


1826-1830. 


Middlesex - - - - 1 in 39 

Lincoln 32 

Berks - S3 

Kent ------ 30 

Monmouth ----- 56 

Northumberland - - - 47 


40 
31 

33 

29 
50 
43 


41 
31 
33 
31 
53 
41 


40 
31 
33 

34 
59 

41 



These proportions are not as considerable as they are found to be 
in the Netherlands, in France, or in Sweden. In the first of these 
countries the proportion from 1814 to 1824 was one in 28.5 indivi- 
duals; in France it amounted from 1817 — 29 inclusive to one in 
32.1; and in Sweden in 1820 to one in 30.8. The proportions varied 
in the different parts of France and Netherlands. In the department 
of Loire, in the first of these counties, it amounted to one in 25f in the 
department of Calvados to one in 43}; while in the Netherlands the 
open country gave one in 29.14; and the cities one in 26.04. As re- 
gards the proportion of births to marriages, it will be found that the 
Netherlands presented in the ten years, 1815-24, an average of 4.6G 
for every marriage. Belgium alone one of 4.72; and France from 
1817 to 1829 one of 4. 105, if we take into consideration the whole num- 
ber of births; or one of 3.815 if we have regard to legitimate children 



Medical Statistics. 173 

only. But we have already stated, that the number of births in England 
and Wales exceeds that reported, and on which the above calcula- 
tions are apparently based. 

In London the average number of births in each of the years in- 
cluded between 1801 to 1811, amounted to 22,156; and in each of 
the years from 1811 to 1821 to 28,490; — the largest number in. 
the first period being 25,426; and the smallest 23,358;«the largest 
in the second period 30,422; and the smallest 26,274. In the year 
1700, the number was 16,585; in 1750, 17,080; and in 1800, 21,776. 
By comparing these sums with the amount of the population exist- 
ing at those different periods, in the five divisions of the metropolis 
from which they are reported, we find, that the ratio of births in 
London in 1700, was one in 40.66; in 1750, one in 38.9; in 1801, 
one in 41.39; in 1811, one in 39.96; and in 1821, one in 41.64; and 
that in 1820, the proportion to marriages was as 2.38 to one. These 
numbers are inferior to those obtained in Paris or Philadelphia; for 
in the former of these cities the proportion is generally one to 31.5; 
and in the latter one to 22.6 of the whole population; while in 1828, 
the proportion to every marriage at Paris was 4.06. We cannot, 
however, be surprised at the difference which is here presented, in- 
asmuch as the number of births reported in London is probably 
greatly inferior to that which really occurs. 

We now proceed to speak of the mortality of England and Wales, 
and of that of London. It can hardly be necessary to premise, that 
in our investigations relatively to the usual mortality of a whole 
country or of a city, and in our endeavours to form an estimate of the 
degree of their healthfulness, it is necessary to base our calculations 
on the results obtained during ordinary years; for every one must be 
aware, that epidemic diseases, or even endemics when they prevail 
with unusual severity, augment often very materially the number of 
deaths and that, if we selected those years as points of comparison, we 
should necessarily arrive at very erroneous conclusions. Nor should 
we select the years immediately succeeding the periods of unusual 
mortality; because experience has shown, as we have already had oc- 
casion to remark, that the latter are generally followed by season of 
great comparative healthfulness. England and its immense metro- 
polis, have experienced several visitations from pestilential diseases, 
which served to swell the number of deaths, on some occasions, to an 
awful degree, and Mr. Graunt cites several years, and others of the 
same kind have occurred since his time, which proved very sickly, and 
presented a mortality of much larger extent than usual, although there 
did not prevail a regular epidemic disease to account for that 

No. XXV.— Nov. 1833. 16 



1 74 Medical Statistics. 

effect. In order therefore to avoid the erroneous conclusions arising; 
from the selection of such sickly seasons, we shall establish our cal- 
culations on a series of years during which no disease of unusual ma- 
lignancy prevailed, and state the average mortality they presented. 

The total number of burials in England and Wales, in each of ten 
yearly periods, from 1790 to 1820, were as follows; 1790, 1,822,902; 
1800, 1,889,574; 1810, 2,053,749; 1820, 2,105,023. This gives an 
average for each year of the first period of 182,290; for each of the 
second of 188,957; for each of the third of 205,374; and for each of 
the fourth of 210,502. In the first the highest number was, (1780,) 
191,736; and the lowest, (1781,) 178,718. In the second the highest 
was, (1794,) 203,328; and the lowest, (1791,) 180,453. In the 
third period the highest was, (1810,) 208,184; the lowest, (1804,) 
181,177. In the fourth the highest was, (1818,) 213,624; the lowest, 
(1813,) 186,477. 

These sums on examination will be found to give the following 
ratio of burials to every hundred marriages in each of the ten years 
ending as above, 1790, 271; 1800, 261; 1810, 246; 1820, 227; or 
to each marriage 2.71; 2.61; 2.46; 2.27. The ratio to births in the 
first period was as 78.42 to 100; in the second as 74.43 to 100; in 
the third as 67.83 to 100; and in the fourth as only 58.73 to the same 
number. 

If now we compare the proportion of mortality to the whole popula- 
tion of England and Wales, we shall find, that in the year 1700, there 
died one individual in every 41^. In 1750, 1 in 42.11. In each of 
the ten years ending with 1800, the average ratio was 1 in every 
45.9. In each of the ten years ending with 1811, 1 in 49.49, and 
in each of the ten ending with 1821, 1 in 56.9. As regards England 
alone, we find, that from 1796 to 1800, the average number was 1 in 
48 annually; from 1806-10, 1 in 51; from 1816-20, 1 in 57; and from 
1826, 1 in 54. 

These statementsH;aken in conjunction with those that precede, 
will lead to the most gratifying conclusions, and deserve in a very 
high degree the attention equally of the statesman, physiologist and 
moralist of all countries; for they show that while the proportion of 
baptisms to marriages has progressively increased during the forty 
years ending with 1820, the proportion of burials to marriages, to 
births and to population, has diminished progressively and conside- 
rably. 

The progressive decrease of mortality has manifested itself not 
only in England generally, but in almost all the counties taken sepa- 
rately, Dorset, Hereford, Oxford, Wilts, York East Riding being the 



Medical Statistics. 



175 



only exceptions during the four quinquennial periods selected by Mr. 
Rickman in the tables of the population returns. 

As may readily be presumed, the ratio of burials to marriages differs 
considerably in the various counties, and has done so in the same county 
at various periods. In the ten years ending with 1790, the counties 
presenting the smallest ratios were Pembroke and Cardigan, both of 
wliich are in Wales; the former giving 205 burials to every 100 mar- 
riages, and the other 211. The highest ratios were in Glamorgan, 
(Wales,) and Surrey; — the former giving 410, and the other 347 to 
100. 

In the ten years ending with 1800, Flint gave a ratio of 205; Car- 
marthen of 205; and Cornwall, (England,) 225; while Surrey gave one 
of 329. 

In the ten years ending with 1810, the county of Cardigan, (W.) 
gave 189; Anglesea, (W.) 191; Gloucester 198; and Hereford 299. 

Finally in the ten years ending with 1820, Anglesea gave 175; 
Pembroke 190; Gloucester 181; Hereford 324; and Flint 300. 

As regards the proportion of mortality to the population of each 
county, it is totally out of our power, interesting as the subject might 
be to those who are engaged in statistical pursuits, to enlarge much 
upon it on the present occasion. We shall, therefore, content ourselves 
with stating the proportions obtained at four quinquennial periods, 
in a few of the more prominent counties. 



1796—1800. 


1806-10. 


1816-20. 


1826-30. 


Dorset 1 in 62 

Middlesex 37 

Kent 41 

Monmouth 72 

Wilts 60 

Surrey - 42 


56 
46 
38 
70 
58 
46 


64 
51 
51 
72 
64 
51 


58 
45 
49 
83 
57 
50 



From this it will be seen that in the first of those periods the high- 
est proportional mortality was in Middlesex, the lowest in Monmouth. 
In the second period Kent presented the highest, and Monmouth 
the lowest. In the third period Kent gave again the highest, Mon- 
mouth the lowest. Finally in the fourth period, Middlesex once more 
gave the highest mortality, and Monmouth the lowest. 

On comparing the above statements with the bills of mortality and 
other documents relative to the movement of the population in France, 
the Netherlands, &c. we shall find, that in having regard only to re- 
gistered burials, England has the advantage over either of those coun- 
tries. Thus in France the proportion from 1817 to 1829 was not 



176 Medical Statistics. 

less than 1 in 39.7. In 1781, it was 1 in 29.2; and in 1802, 1 in 
30.1. In the Netherlands each of the ten years 1815, 24 presented 
an average mortality of 1 in 39.86 — varying from 1 in 36.32, (1817,) 
to 1 in 43.93, (1824.) In general the average number in that coun- 
try is I in 42. In Belgium alone it \s 1 in 43; and in Sweden 1 in 
41.07, (1820.) 

The mortality in the different provinces of Belgium varied from 1 
in 39, (West Flanders,) to 1 in 56, (Namur.) In France also the 
proportion varied in the ten years 1817-27 from 1 in 27|, (Finistere,) 
to 1 in 53.5, (Haute Pyrenees.) Thirteen rich provinces in five 
years presented an average of 1 in 46.31; while in 14 of the poorest 
departments the average was 1 in 33.72. 

In France the proportion of births to deaths in the twelve years 
1817-29 was 1.24 to 1. According to calculations founded on the 
census of 1827, it appears that there occurred in France 1,000 births to 
798.48 deaths; the proportion varying in the different departments 
from 1027.60 deaths to 1,000 births, (Finistere,) to 656.38 deaths to 
1,000 births, (Sarthe.) 

With regard to the mortality of London, Mr. Marshall's tables 
show that the absolute numbers of deaths have not varied very consi- 
derably from 1780 to the present day. Nevertheless the variations 
they do present, taken in conjunction with the very remarkable in- 
crease of population in the metropolis, prove that the proportional 
mortality has greatly diminished. This will be rendered apparent 
by the following statement. The average annual mortality of London 
within the bills, from 1780 to 1790, was 23,080; from 1790 to 1800, 
26,508; from 1800 to 1810, 19,927; from 1810 to 1820, 23,3S1; and 
from 1820 to 1830, 21,909. The average of those five periods taken 
conjointly is 22,950, or one thousand more than the full amount of 
the last period taken singly. 

The proportion of the mortality to the population in 1631, was 1 
in 21; in 1700, it was 1 in 34.26; in 1750, one in 27.56.* The 
proportion between 1790 and 1800, calculated on the population as 
returned in 1801, was 1 in 29.35; between 1800 and 1810, calcu- 
lated on the population of 1811, 1 in 44.56; between 1810 and 1820, 
1 in 45.02; and finally, between 1820 and 1830, 1 in 55.81. In 1831 
the mortality was 25,337, or 1 in 48.27. 

Our readers will immediately perceive the difference of the rates of 

* These proportions are calculated on the mortality reported by Marshall 
in his general tables at the end of the volume. At page 63 he gives a different 
return of deaths in 1700 and 1750; and at page iv, calculates on the last num- 
bers. Hence he finds that in the first of these years the mortality was 1 in 33, 
and in the second, 1 in 26. 



Medical Statistics. 177 

mortality in England generally, and in London in particular, and the 
smaller proportion of deaths in the whole country considered in the 
aggregate, and the counties taken separately. Some of the tables con- 
tained in the works before us, tend in some degree to establish this 
fact in another way; for they show, that at the very periods when the 
mortality exceeded the births in London — from 1700 to 1801, many 
of the counties, Lancashire and the West Riding in Yorkshire, for 
example, presented seldom, if ever, a similar result; the baptisms ge- 
nerally exceeding the burials. 

We have already, in an early part of this article, stated the rela- 
tive proportion of burials to births in London. Our statements then 
had reference to the metropolis generally — both within and without 
the walls. The bearing of the subject on the one which at present 
occupies our attention, will be a sufficient excuse for recurring to it 
again, with the view to point out the influence of locality on the mor- 
tality of the different districts of which London is composed. It is 
natural to presume, that in all large cities there are some portions 
which prove more sickly than the rest, and where consequently the 
mortality is more considerable. Places of the sort constitute, as it 
were, small communities, embracing various kinds of localities, and 
containing individuals placed under circumstances of the most oppo- 
site character. In Paris, for example, Mr. Villerme has found, that 
the mortality in the private houses of the first arrondissement, amount- 
ed to 1 in 5 8 T 2 ^-, while in those of the twelfth, it arose to 1 in 42.63; 
the first arrondissement representing the richer, and the twelfth the 
poorer portions of the city. Including the deaths occurring in the 
hospitals, and which take place principally among individuals sent 
from the poorer districts, the mortality in the first arrondissement 
amounted to 1 in 41.20; while in the twelfth it rose as high as 1 in 
24.81. Facts of a similar import may be stated in reference to Phila- 
delphia, where the mortality among the blacks, who inhabit the worst 
parts of the city, was found by Dr. Emerson, to amount to 1 in 21.7; 
while that among the white population did not exceed 1 in 42. 3. 

As may be expected, London does not differ in that respect from 
other large cities. In all the years between 1700 and 1802, the burials 
presented a greater excess, comparatively with the population, over 
baptisms in those districts within the bills where the houses are more 
compactly built; and from 1802 to 1820, the excess of baptisms over 
burials, which, as we have seen, obtained in the whole metropolis, 
was proportionally less considerable than in the other parts. Thus, 
we find, that in 1760, the excess of burials over baptisms within the 
bills of mortality, was 4,879; while in the whole metropolis, it was 

16* 



17S Medical Statistics. 

only 4,845. In 1770, within the bills, it was 5,325, and in the whole 
metropolis, 5,159. The excess of mortality over baptisms, though 
often large in the city proper, was particularly and sometimes extra- 
ordinarily so in the out parishes within and those without the bills; 
while in the city and liberties of Westminster, though more con- 
stantly observed, it was usually comparatively small. It is a fact 
worthy of notice in this place, that from a table exhibiting the burials, 
baptisms, &c. in each of nine years, from 1700 to 1780, and in each 
of the forty years, from 1781 to 1820, the number of baptisms is 
found to have exceeded that of burials twenty-four times in that part 
of the metropolis within the walls; and that on twelve of these occa- 
sions, which occurred previous to 1802, the burials exceeded the bap- 
tism in all the parishes within the bills. A similar excess of baptisms 
occurred thirty-nine times during the period above-mentioned in that 
part of the city situated without the walls. On eighteen of these occasions 
the burials exceeded the baptisms in all the districts of the metropolis 
taken collectively — this difference arising from the very considerable 
excess of burials in the out parishes within and without the bills, where, 
until the year 1802, the baptisms very rarely predominated over the 
burials. The different degrees of healthfulness of the various districts 
of the metropolis, as well as their progressive improvement in that 
respect, might be satisfactorily established by comparing the propor- 
tion of deaths to the population in each of them at various periods. 
But this we cannot undertake to do, owing to the impossibility of as- 
certaining the population of each district in different years; as well as 
to the time and space the investigation would require, even if we had 
the necessary materials at our command. 

It would no doubt also be an object of some interest to ascertain 
the different rates of mortality at various periods in the separate par- 
ishes comprised within the bills. Mr. Marshall's work offers a part 
of the materials for such an inquiry. But in order to derive full 
advantage from the latter, it would be necessary to place in apposi- 
tion to the statement of deaths in each parish, an account of the na- 
ture of the localities, of the character, occupation, and mode of life 
of the inhabitants, and of other circumstances, relatively to which in- 
formation is not of easy access in this country. 

The above calculations in respect to the mortality of London, as 
well as of England and Wales generally, have been based on the 
numbers obtained from the parish registers. But from the causes to 
which we have already alluded, it will be evident, that the compara- 
tive, but not the absolute mortality, in various years in that country,. 
can be relied upon; since a large number of deaths are not reported, 
and consequently not noticed in those registers. In the whole oC 



Medical Statistics. 179 

England and Wales it is computed, that in the ten years, 1801-11, 
there were 103,560, and in the ten years, 1811-21, 95,030 unenter- 
ed deaths. These of course would increase the proportional numbers 
far above those we have mentioned; presenting 1 in 43.20 between 
1801-11, and 1 in 48.28 between 1811-20. As regards London in 
particular, it is supposed that about 8,000 burials are thus deficient. 
These added to 25,337 reported in 1831, would give 33,337, or 1 in 
36.7, instead of 1 in 48.27, as stated above. These facts will lead 
us to the conclusion, that in expressing the opinion, that the mor- 
tality of Great Britain, its cities, and its hospitals, is greatly inferior 
to that of any other country in Europe, and that Great Britain is at 
present the most healthy country with which we are acquainted, Dr. 
Hawkins has somewhat exaggerated the superiority of his country. 
For it the number of unregistered burials throughout England and 
Wales be taken into consideration, the superiority of these countries 
over France will not be found sufficiently great to justify so decided 
a boast on the subject. If we compare the average mortality of Lon- 
don as stated above, with that of other cities of Europe, or of this 
country, we shall also find, that although the comparison will give 
satisfactory results, the superiority is far from being such as to autho- 
rize the assertion made by the same writer that the most favoured 
spots in Europe, the places which have long been selected as the re- 
sort of invalids, and the fountains of health, are more fatal to life 
than even the great metropolis. In Belgium it is not more than 1 in 
36.9, while in Paris the average proportion in the five years, 1817-21, 
amounted to 1 in 32.43.; and from 1821 to 1826, to 1 in 36.44. But 
if the cities we have mentioned do notpresentagreaternumberof deaths 
than London, our own city, Philadelphia, was greatly superior to it in 
point of healthful ness in the twelve years, 1807-20; for the aver- 
age mortality in that period, according to Dr. Emerson, was 1 in 
47.8 — the proportion varying from 1 in 38.25 (1820) to 1 in 56.53 
(1815.) It is proper to remark, however, that from 1820 to 1830, 
the advantage was less decided; for during that period the mor- 
tality varied from 1 in 30.58 to 1 in 42.94, which gives an average 
of 1 in 38.85. But this period, it should be recollected, was one of 
unusual sickliness over the whole country, and cannot, therefore, af- 
ford correct criteria for judging of the ordinary proportions of the 
mortality in this city, or in other parts of the United States. 

It would be difficult at the present time, and in this country espe- 
cially, to ascertain with accuracy whether the number of sick in 
England and London is greater among individuals of one sex than 
among those of the other, though we may presume, from what we 
observe here, that physicians are more employed among females. 



180 Medical Statistics. 

With respect to mortality, however, we are furnished by Mr. Mar- 
shall with documents showing the difference of the proportion in the 
two sexes. In nine ten yearly periods, from 1700 to 1780, and in 
forty consecutive years, 1781 — 1820, the mortality among females in 
all England and Wales, exceeded that among males nineteen times, 
and that among males exceeded that among females thirty times. From 
1802 to 1821, a larger mortality among males occurred in every year but 
one, (1819,) the excess amounting from 1801 to 1821, to little short 
of 26,000, or 1,300 every year. As during the whole of that period 
the female population exceeded the male, this fact alone will show 
plainly that the mortality among the latter is much greater compara- 
tively than among the former, and consequently that the value of life 
in England, &c. is in favour of females. On examination, it will be 
found, that the proportion of deaths was as 72 among the males, to 
71 among the females, while the average proportion of the sexes in 
1801 and 1811, was as 12 females to 11 males, and in 1831 as 38 
females to 37 males. Independently of this it may be remarked, 
that the proportion of deaths among females to the whole number 
of that sex in each of the years, 1801-11, was 1 in 54.62, while the 
proportion at the same time among males, was 1 in 49.66. In London, 
in particular, it is found, judging from the average mortality in each 
of the ten years, 1810-20, and the population of 1821, that the pro- 
portion of deaths among males is 1 in 49, and that among females 1 
in 57.21. These facts relative to the greater value of life among fe- 
males are fully corroborated by the results of calculations made by 
Mr. Finlaison the Actuary of the national debt, who found that ex- 
cept under the age of 12, and above 85, extreme periods, at which, 
perhaps, no distinction of mortality is apparent, there is at every 
other period a remarkable and decided advantage in favour of the 
female. 

The same difference of mortality among the sexes is observed in 
France entire, where the average from 1817 to 1829, was 55 male to 
53 *t 9 ow female deaths. In Paris, on the contrary, the mortality 
among females is in the proportion of 53 of that sex to 47 males in 
every 100 deaths. The number of deaths among males in Philadel- 
phia is also greater than among females, — the proportion being in a 
period of sixteen years, 77 females to 100 males. 

If we have regard to the proportion of tke mortality to the births 
among the two sexes, we shall find that in France there occur 1000 
births to 781.93 deaths among individuals of the male sex, or 4 births 
to 3 deaths, — the proportion varying in the various departments from 
1017.21 deaths to 1000 births, (Finistere,) to 612.26 to 1000, (Creuse.) 
Among the females there occur, in France entire, 816. 12 deaths to 1000 



Medical Statistics. 



181 



births, the proportion varying from 1037.93 to 1000, (Finistere,) to 
64S.24 to 1000, (Hautes Pyrenees.) This is equal to 6 births to 5 
deaths for the whole country. Taking an equal number of male 
births, of births of both sexes indiscriminately, and of female births, the 
respective mortality among these three classes will be found to bear 
to each other the same relation as the numbers 46, 47, 48. 

As regards the city of London alone, we find that in a period of 
103 years, from 1728 to 1830, inclusive, the mortality among females 
exceeded that among males forty times only. Since 1800, the excess 
of deaths among females has only occurred once, (1816,) — the propor- 
tion from 1801 to 1821 being as 29 males to 28 females, while we 
have seen that the female population in 1811 was to the male as 7 to 
6, and in 1821 as 8 to 7. 

Mr. Marshall has furnished at pp. 70, 71, two interesting tables, 
showing the number of deaths within the bills of mortality in each 
of thirteen gradations of ages in each of the 103 years, 1728 — 1830. 
These tables, as Mr. M. himself remarks, bespeak a very marked 
change in the physical condition of the metropolitan population since 
1740. The number that died under two years of age in the ten years, 
1740-9, was as 34 to 29 in the ten years, 1820-9, while of those 
from 2 to 29, the number that died in the latter ten years, exceeds 
the number in the former by 1 in 17. From 20 to 50 the numbers 
in 1740-9, were as 29 to 25 in 1820-9; and of those fifty years of 
age and upwards, the number in the ten years, 1740-9, was as 28 
to 22 in the ten years, 1820-9. * 

* The following statement will show the number of deaths at each of the 
thirteen gradations in London during- the year 1828, as well as the number 
during" the same year at Paris; the latter being 1 added for the purpose of com- 
parison. 





LONDON. 


Proportion to 
population. 


PARIS. 


Proportion to 
population. 


Under 2 years 


6389 


1 in 18S.51 


6392 


1 in 137.73 


From 2 to 5 


2326 


. 504.06 


1789 


500 


5 10 


878 


1335.36 


962 


925.6 


10 20 


861 


1361.3 


1151 


773.50 


20 30 


1488 


788. 


2613 


340.75 


30 40 


1790 


655 


946 


941.2 


40 50 


1985 


590.65 


1781 


500. 


50 60 


1845 


635.4 


1831 


476.3 


60 70 


1891 


620.01 


2466 


361.07 


70 80 


1540 


761.33 


2410 


369. 


80 90 


615 


1906.42 


815 


1091.21 


90 100 


100 


11724.50 


67 


13289.55 


100 and upwards | 


1 1 


1172450.00 







This calculation is made on the known population of Paris in 1827, and on 



182 Medical Statistics. 

In a series of tables placed at the end of his work, Mr. Marshall 
has presented a statement of the number of deaths within the bills of 
mortality under various heads of diseases and casualties in each of 
the 204 years, 1629 — 1831. This space he divides into four periods. 
The first includes all the time between the years 1629-89; the second 
extends from 1690 to 1739; the third from 1740 to 1789, and the 
fourth from 1790 to 1831. These tables are highly interesting, as 
showing the degree of prevalence of certain diseases, the diminished 
frequency or the extinction of some, and the appearance or increased 
fatality of others in the course of the four periods mentioned. 

The already considerable length of this article will force us to be 
rather brief on the subject of the contents of those tables, and to 
limit ourselves to stating a few facts relative to some of the prin- 
cipal diseases. The first column in each table has reference to the 
number of deaths in child-bed. From these tables it will be found, 
that the mortality arising from this cause has greatly diminished, for 
they show that the annual average of deaths in the puerperal state 
was 234 during the first period, and 201 during the last, although the 
number of births was nearly as two in the latter period to one in the 
former. This is certainly highly creditable to the resources of the 
obstetrical art. Abortion and still-born appear to have remained 
more uniform, the annual number varying from about 350 to 900, 
but not increasing progressively each year from the first to the latter 
of these sums. In 1629, the number was 499; in 1649, 327; in 1685, 
759, in 1800, 492; and in 1831, 898. In only one year, (1828,) did 
it exceed 1000. If we have regard to the great increase of the popu- 
lation of London in each of the four periods, it will become evident, 
that although the average mortality from the above-mentioned cause 
does not differ now very materially from what it was formerly, the 
population has nevertheless decreased considerably. 

" The first and second periods exhibit a column headed Chrisomes and In- 
fants. Chrisom is a Greek word, signifying an ointment, used apparently to sup- 
ple or soften the first garment or cloth of infants at their birth: its use in the 
first instance probably emanated in kindness, and was afterwards converted into 
a superstitious practice by the priests of both the Greek and Romish churches. 
The custom appears to have been, to use the anointed, or Chrisom cloth for 
one month from the birth of the child, and if the child died within that month, 
it was stated to have died in Chrisome. This ridiculous custom, it will be seen, 
gradually decreased in the metropolis of England from 1629 to 1726, when it 

the estimated population of London in the same year. It is not, therefore, given 
as correct, but only as approximative. But such as it is, it will serve to show, 
that except between the ages of 30 and 40, and 90 and 100, the chances of life are 
greater in London at any of the gradations we have mentioned, than in the 
French metropolis. 



Medical Statistics. 183 

became quite extinct. As the number of deaths reported in Chrtsome decreased, 
those under the head Convulsions will be seen to have increased, the cause of 
death in both cases probably having- been the same." 

The number reported under the head of Chrisome in 1629 was 
2,596. 

The number of children cut off by teething did not amount to more 
than 500 annually until 1646, when it suddenly increased \evy con- 
siderably. The average from this period to 1752, was about 1,500 
annually. Since then it has gradually diminished; to such an extent, 
indeed, that from the year 1781 to the present time, the average 
number has not exceeded three or four hundred annually; while the 
births within the bills of mortality have in the same period increased 
from about 19,000 to upwards of 25,000. Rickets, as it appears from 
Mr. Marshall's tables, and as we learn from Graunt's work, was not 
reported until 1634, when fourteen deaths are mentioned as having 
taken place from it. From this circumstance Graunt concluded that 
it was then a new disease. But be this fact, which if true would be 
an interesting one, as it may, the disease prevailed very extensively 
from 1647 to 1715; there being from 150 to more than 500 deaths 
from it alone every year. From the latter period it gradually but 
constantly declined, so that the average number from 1750 to 1790 
did not exceed five. Since that period the disease has become totally 
extinct. 

Convulsions increased very considerably from 1632 to 1710; the 
numbers varying in that period from 221 to 5,987. It is to be re- 
marked, however, that many cases of death mentioned in the earlier 
part of the same period as having occurred in Chrisome, ought pro- 
bably to have been referred to convulsions. From 1710 to 1772 the 
disease continued to be extremely fatal; the number of deaths from it 
being seldom less than 6,000, and often higher than 8,000. From 1772 
to the present period, the mortality from convulsions has gradually di- 
minished; the annual number of deaths reported being now less than 
3,000. 

After noticing, in his introductory chapter, the gradual dimi- 
nution of the above-mentioned diseases, a fact which is justly consi- 
dered as honourable to the assiduity and integrity of the members of 
the medical profession, Mr. Marshall remarks, that there are some 
indications of nature seeming determined to cross the purposes of 
the latter in despite of all their assiduity; croup, cough, and dropsy 
in the brain, indicating a determination, since 1790, to fill up the 
void of mortality which the diminution under the other heads seemed 
disposed to occasion. Cough and hooping cough are not returned in 



184 Medical Statistics* 

the two first periods. From 1740, when the number of deaths from this 
disease was 280, to 1831, the mortality from it has greatly increased. 
The number in 1803 was 1004, and in 1831, 1,738. In the inter- 
vening years it varied from 326 to 864. Croup was not reported till 
1793, when there were twelve fatal cases of the disease. From that 
period the number has increased very considerably* being, in 1830, 
126, and in 1831, 119. In the three first periods, from 1629 to 1790, 
dropsy in the brain is reported under the heads of headmoldshot, 
horse-shoe head, and water in the head. Mr. M. thinks, that prior 
to 1790 the disease may have been confounded with convulsions. 
From the first year to 1715, the average number did not exceed 
twenty-five annually. From that year to 1752, the number rose to 
150. After that year the deaths gradually diminished to 50 annually; 
but in 1790 they once more began to increase, and have ever since 
continued to do so to an alarming extent; the number ranging during 
the last few years at little less than 800 per annum. 

If now we take a general survey of the mortality from all the diseases 
incident to infancy, we shall find that the number of deaths in each 
of the years included within the first period, 1629 — 1690, varied from 
2,715 to 7,280, the number gradually increasing in the course of that 
time. In the second period, 1690 — 1739, it varied from 5,556 to 
12,611. In third period, 1740— 1790, it varied from 5,579 to 11,556, 
the number gradually decreasing. In the fourth period, 1790 — 1831, 
the mortality varied from 5,057 to 7,144 — the latter number occur- 
ring in 1831, and those in the other years differing little from the 
first of the last-mentioned sums. Having regard, therefore, to the 
difference of the population in the districts within the bills during the 
four mentioned periods, and to its immense augmentation during the 
last, we cannot but be sensible of the fact, that the mortality from 
diseases incident to infancy has considerably diminished. 

In the first period the deaths from consumption varied from 1,731 
to 4,808 annually. In the second, from 2,520 to 4,601. In the third 
period, from 3,411 to 5,721; and in the fourth, from 3,432 to 5,732. 
But the reports of this disease are blended, from 1690 to 1700, and 
from 1729 to 1739 with asthma and tissick, so as to leave us very 
much embarrassed in our inferences. The uniformity of the mortality 
from that disease for the last hundred years, is certainly surprising. 
But the report must be looked upon as favourable rather than other- 
wise, seeing, that during the period in question, the population of 
the metropolis has more than doubled itself. It is possible, that dur- 
ing the first period a number of deaths occurring from different dis- 
eases were classed, through ignorance or design, under the head of 



Medica I Statistics. 185 

consumption, and that in this way the reported mortality from that 
disease was considerably swelled. This, indeed, we are inclined to 
believe, from a comparison of that mortality with the one occasioned by 
all the diseases combined, and with the population of London at the 
time, as well as from the statement of Graunt, who affirms the fact in the 
most positive manner. Prior to 1690 asthma is not specified Since 
that period the number of deaths from that disease has varied from 1 
to 1,150. But in the instances in which the number is found to be so 
considerable, the disease is blended, in the reports, with tissick, 
which, from 1702 to 1729, is mentioned in a separate column, the 
numbers in which vary from 241 to 511. 

The number of deaths reported as having resulted from French 
pox differed considerably in the four periods. In the first it varied 
from 7 to 114 — the average annual number being 29.65. In the se- 
cond it varied from 29 to 159, with an average of 41.02. In the third 
period, from 32 to 162, with an average of 85.4; and in the fourth, 
from 1 to 86, with an average number of 20.8. Viewing the great 
increase of the population in the fourth period, the decrease of mor- 
tality from the disease is remarkable and highly gratifying. From the 
injudicious mode of treating syphilis in the seventeenth century, we 
might be led to experience surprise at the small number of deaths re- 
ported in the first and second periods, compared with those reported 
in the third, were we not informed that during the first, at least, 
many deaths occasioned by the jnalady were reported under other 
heads. On this subject Graunt expresses himself in very positive 
terms. 

'* We finde one casualty in our bills, of which, though there be daily talk, 
there is little effect, much like our abhorrence of toads and snakes, as most poi- 
sonous creatures, whereas few men dare say upon their own knowledge, they 
ever found harm by either; and this casualty is the French pox, gotten for the 
most part, not so much by the intemperate use of venery, (which rather causes 
the gowt,) as of many common women. I say, the bills of mortality would take 
off these bars, which keep some men within bounds as to these extravagancies: 
for in the afore-mentioned 229,250, we find not above 392 to have died of the 
pox. Now, forasmuch as it is not good to let the world be lulled into a security, 
and belief of impunity by our bills, which we intend shall not be onely as death's- 
heads to put men in minde of their mortality, but also as mercurial statues to 
point out the most dangerous ways, that lead us into it, and misery. We shall 
therefore shew, that the pox is not as the toads and snakes afore-mentioned, but 
of a quite contrary nature, together with the reasons, why it appears other- 
wise. Forasmuch as by the ordinary discourse of the world it seems a great part 
of men have, at one time, or other, had some species of this disease, I 
wondering why so few died of it, especially because I could not take that to be 
so harmless, whereof so many complained very fiercely; upon inquiry I found 

No. XXV.— Nov. 1833. 17 



186 Medical Statistics. 

that those who died of it out of the hospitals, (especially that of King's Land, 
and the Lock in Southwark,) were returned of ulcers and sores. And in brief 
found, that all mentioned to die of the French pox were returned by the clerks 
of Saint Giles's, and Saint Martin's in the Fields onely; in which place I under- 
stood that most of the vilest, and most miserable houses of uncleanliness were; 
from whence I concluded, that only hated persons, and such, whose very noses 
were eaten of, were reported by the searchers to have died of this too frequent 
maladie." 

From 1629 to 1710 the small-pox and measles appear to have been 
as remarkable for their variableness as some other diseases for their 
uniformity. Subsequent to the introduction of inoculation the small- 
pox became far more general and confirmed in its virulence — occa- 
sioning an increased rate of mortality, which continued up to the pe- 
riod of the introduction of vaccination. Since that time the disease 
has gradually abated. In the first period, 1629-89, the highest mor- 
tality from the disease was 2,507. On twenty-four occasions it ex- 
ceeded 1,000, and on four, 2,000. In the second period, 1690 — 1739, 
the number of deaths varied from 196 to 3,271. On forty-one occa- 
sions, it exceeded 1,000; and in eleven of these it rose beyond 
2,000, and on five beyond 3,000. In the third period, 1740-89, the 
number fell short of 1,000 only four times; on seventeen occasions it 
exceeded 2,000, and on seven 3,000. Finally, in the fourth period, 
1790—1831, the mortality varied from 421 to 3,548, (1796.) On 
twenty occasions only did it exceed 1,000. From the year 1800 it 
has fallen short of that number nineteen times; the average being 
now from five to six hundred annually. 

It is a fact which seems in a very high degree to deserve attention, 
that the measles, which continued exceedingly variable and moderate 
down to 1800, except on particular years, have become, since that 
date, greatly increased and confirmed in virulence. In the year 1801 
the mortality from that disease was 136; in 1808, 1,386; in 1816, 
1,106; in 1831, 750: — the average number in the thirty years, being 
662.50. 

Ague and fever were reported together from 1629 to 1701; and se- 
parately from the latter period to 1780. Spotted fever, which, in the 
first period, was mentioned separately, was reported together with 
purples from 1690 to 1700. After that period these diseases are 
once more mentioned separately. From 1729 to 1730 they are again 
reported together as well as with fever; ague being now placed in a 
distinct column. In the third period, 1740-89, no mention is made 
of spotted fever or purples, and in the fourth, ague-is not spoken of 
separately. From this circumstance, we must either infer, that some 
of the diseases we have mentioned disappeared from London, or that 



Medical Statistics. 187 

they have all been lately confounded together under the generic name 
of fevers. From 1629 to 1689 this form of disease seems to have been 
exceedingly variable in respect to frequency. From that period to 
1750 it became more uniform and general; but from that year to the 
present time it seems gradually to have declined. In 1750 there 
were 4,292 deaths from that disease. In 1800 the number had dimi- 
nished to 2,713, and in 1831 it was reduced to 965. The average 
annual number in the ten years, from 1750 to 1760, was 2,781; from 
1760 to 1770, it was 3,514; from 1770 to 1780, 2,678; from 1780 to 
1790, 2,473; from 1790 to 1800, 1,935; from 1800 to 1810, 1,777; 
from 1810 to 1820, 1,072; from 1820 to 1831, inclusive, 916. 

Inflammations, on the other hand, have increased in a greater ratio 
than fevers have declined. In the second period the number varied 
from 1 to 63. In the third period, from 35 to 308; and in the fourth, 
from 142 to 2,399. Pleurisy, which is reported separately, varied in 
its fatality; in the first period, from 9 to 45; in the second, from 6 
to 77; in the third, from 9 to 70; and in the fourth, from 3 to 
37. It is presumable, however, that many cases of deaths from pleu- 
risy are reported under the head of inflammation, inasmuch as it is 
difficult to suppose that in so populous a city as London, so few 
deaths should be occasioned by a disease which carries off annually 
about 40 individuals in New York, and upwards of 200 at Paris. In 
speaking of the mortality from inflammation and fevers, Mr. Mar- 
shall remarks, that supposing the distinctions to have been properly 
made in the reports, the decrease of fever and increase of inflamma- 
tions, are features of peculiar interest, and may be regarded as addi- 
tional evidence of the inscrutable working of nature and its every va- 
rying yet uniform process. For our parts, without wishing to deny 
that inflammations have increased, and that the fevers of nosological 
writers have diminished in frequency, we are inclined to believe, judg- 
ing from the change we know to have occurred in the views of physi- 
cians in this and other countries respecting the relationship of those dis- 
eases, that the practitioners, and even the searchers of London, have 
experienced a similar change in their sentiments, and that at present, 
and for some years back, many cases of serous and mucous inflam- 
mations are, and have been, reported under their true name, which, 
would formerly have served to swell the list of deaths from fevers. 

Dropsy appears to have progressively increased from 1629 to 1750. 
In the first of those years, the number of deaths from that malady 
amounted to 235. In 1689 it attained to 971; in 1740, 1,219; and in 
1750, 1,051. Subsequent to this date, the disease seems to have 
somewhat abated until 1810, since when it has once more manifested a 



188 Medical Statistics. 

tendency to increase. In the latter year, the deaths reported were 778, 
and in 1831, they were returned, after a gradual increase during the 
intermediate period at 1,108. Considering, however, the difference 
between the population of 1750 and that of 1831, we cannot help 
being struck with the decreased prevalence of the disease. In the 
former, the deaths from it were 1 in 622.17 of the population, and 1 
in 23 of the total mortality of that year; while in the latter it was 1 
in 1104.7 of the population, and 1 in 23 of the total mortality. 

In the first period the deaths from palsy varied from 10 to 31, and 
those from apoplexy from 17 to 138, the increase being progressive. 
In the second period the deaths from palsy varied from 14 to 46 — 
those from apoplexy from 71 to 243. In the third period the number 
from palsy was from 41 to 105, and from apoplexy from 178 to 276. 
Finally, in the fourth period palsy gave a mortality of from 62 to 
246, and apoplexy one varying from 187 to 555. From this it will 
be perceived, that apoplexy and palsy are becoming gradually more 
prevalent, particularly since the commencement of the last of the 
four periods. It is proper to remark, that in many of the years com- 
prised in those periods, apoplexy and suddenly, which were con- 
founded together for a considerable time, are reported separately. 
But it is probable that, at least the majority of the deaths classed 
under the head of suddenly, were occasioned by apoplexy, because 
sudden deaths from accidents are mentioned in a separate column. 
For this reason we have not considered them separately. 

In the first period, 1629-89, which includes several of the years 
during which the plague prevailed with most virulence in London, the 
disease is mentioned thirty-seven times, from 1630 to 1679, inclusive. 
From the tables now under consideration, it will be found that in the 
first of those years there were 1,317 deaths from that pestilence; in 
1636, 10,400; in 1647, 3,597; in 1665, 68,596, and in the following 
year, 1,998. The total number of burials in those years was 10,554; 
23,359; 14,059; 97,304, and 12,738. In all the other years men- 
tioned, with the exception of 1631, when the deaths from plague 
amounted to 274, and 1648, when they exceeded 600, the mor- 
tality was trifling. The disease has not been returned since the year 
1679, under the name of plague; but Mr. Marshall reports in his 
second table, down to 1740, a number of deaths under the head of 
stopping of the stomach, rising of the lights, surfeit, looseness, vomit- 
ing, and twisting of the guts, which diseases, according to him, ap- 
pear to partake of the character of the plague or pest of 1665, or of 
the cholera of 1831-2. 

The following table, which we have prepared from several exten- 



Medical Statistics. 189 

sive ones contained in Mr. Marshall's work, will show the number of 
deaths from the plague in several visitations of the disease prior to 
the years already mentioned, together with the total number of 
burials. 

Total burials. Deaths from plague. 

1593 - - - 25,886* -. - - 11,503 

1603 - - - 42,042f - - - 36,269 

1606 - - - r,920 - - - 2,124 

1607 - - - 8,022 - - - 2,352 

1608 . - - 9,020 - - - 2,262 

1609 - - - 11,785 - - - 4,24a 

1610 - - - 9,289 - - - 1,803 
1625 - - - 54,265 - - - 35,417 

During the intervening years, and until 1630, the disease prevailed 
to a greater or less extent, the deaths varying from 3 to 8964 

It is proper to remark in concluding this statement of the mortality 
occasioned in London by the plague, that considerable as it certainly 
often was between the years 1592 and 1667, it appears, from the re- 
ports of historians, to have been much greater during the fourteenth 
century — the limited extent of the population at that time being taken 
into consideration. Between July 1348, and September 1349, up- 
wards of 50,000 persons are stated to have been cut oft' by the disease 
in the metropolis.§ During the same season, 7,000 died at Yarmouth, 

* Mr. Graunt gives these as the numbers for 1592, and states that the mor- 
tality in 1593, was 17,846, and the deaths from the plague 10,662. Mr. Mar- 
shall makes no mention of the plague of 1592. 

f Another account makes the number 37,294, and from plague, 30,561. Mr. 
Marshall places no reliance on either statements; but Mr. Graunt adopts the 
latter without, however, assigning his reasons. 

* The seventeenth century appears to have been a period of pestilential de- 
solation all over the world. From 1618 to 1655, several places on the continent 
of Europe were ravaged by the disease; in 1656, Naples lost 300,000 of its in- 
habitants; in 1657, Geneva 70,000; in 1632, Amsterdam 24,148. See Marshall, 
p. 66, for farther details on the subject. 

§ As regards the mortality from this disease in London, considerable difficulty 
is experienced in arriving at the truth. Some historians state the number of 
deaths to have been 57,354. But Mr. Marshall thinks that this number must 
be regarded as indicating the mortality of Norwich, and not of London. Ac- 
cording to Rapin, above 50,000 persons are stated to have been buried in a 
churchyard belonging to the Cistercians; but Mr. Johnes, the annotator of Sir 
John Froissart's Chronicles, states that the number buried there, amounted to 
200 daily; and Holinshed, who was probably Mr. Johnes* authority, states that 
besides great number of bodies buried in other places, there were interred from 
Candlemasse till Easter, in the said churchyard, 200 dead corpses daily. "Now* 
in no year could Candlemasse till Easter embrace a period of more than eighty 

17* 



190 Medical Statistics. 

above 57,000 at Norwich, and a considerable number in various other 
parts of England, Wales, and Scotland. This century, like the 
seventeenth, was one of great desolation throughout the world; for 
according to an official report to Pope Clement, 23,840,000 persons 
are stated to have died within the pale of the See in one year, (1347.) 
In England it entirely disappeared before the end of August, 1349, 
and the mortality in other parts, subsequent to 1350, " was probably 
occasioned as much, or more, by the privation and destitution of all 
social comfort, in which such a calamity was calculated to leave 
large numbers of survivors, as from any marked or specific pestilen- 
tial disease." 

In addition to the plague of 1348-9, Holinshed states that in 1479, 
"there was great mortality and death by pestilence, not onlie in 
London, but in diverse parts of the realme, which began in the latter 
end of September, in the yeare last before passed, and continued all 
the yeare till the beginning of November, which was about fourteen 
months; in which space died innumerable of people in the said citie 
and elsewhere." And again in 14, 15, Hen. VII. 1499, "the next 
yeare after, there was a great plague whereof men died in many 
places verie sore; but epecialle, and most of all, in the citie of Lon- 
don, where died in that year thirtie thousand." 

Finally, the years 1545 and 1563, appear to have been great plague 
years, for we are informed in a tract entitled Flagellum Dei, consist- 
ing of a collection of the several fires, plagues, pestilential diseases, 
&c.that happened in London, especially since the Norman conquest, 
that in the first of the above-mentioned years, there died in London 
a very considerable number of individuals, and in the latter 21,500. 

L. 

days, 200 daily during 1 such period gives only a total of 16,000, instead of above 
50,000, as stated by Rapin. Mr. Rickman, the author of the Population Returns, 
computes the mortality from the plague in London in 1348, at 100,000, but he 
is not borne out in this opinion by any of the authorities that he himself quotes. 



( 191 



BIBLIOGRAPHICAL NOTICES. 

XIII. An Account of the Life, Lectures, and TVritlngs o/ William Cullen, M. D. 
Professor of the Practice of Physic in the University of Edinburgh. By John 
Thomson, M. D., F. R. S. L. and E. Professor of Medicine and General Pa- 
thology in the University of Edinburgh. In two volumes, 8vo. Vol.1. Edin- 
burgh and London, 1832. 

Dr. Thomson very properly remarks, that among the many eminent teachers 
of medicine to whom Great Britain has given birth, there is no one who, by his 
lectures and writings, has had a greater influence on the opinions and practice 
of medical men, and on the general progress of medical science than Dr. Cullen, 
and that it may be justly, therefore, matter of surprise, that so many years have 
been suffered to elapse since the death of that distinguished man without the 
publication of any authentic or correct history of his life and studies. This de- 
sideratum Dr. Thomson has now undertaken to fulfil from Dr. Cullen's papers, 
consisting of letters from private friends, sketches of essays, notes of lectures, 
and medical consultations, which were placed in his hands after the death of 
Dr. Cullen's eldest son, Lord Cullen, who had entertained the laudable desire 
of writing a biographical memoir of his father. 

The work under notice, of which the first volume only has as yet appeared, is 
replete with interest, and will contribute largely to enhance the reputation of the 
author, from the great erudition, and the familiar acquaintance with the doctrines 
of Dr. Cullen and of his predecessors, it displays, and the accurate exposition of 
the state of medical science during the eighteenth century therein contained. It 
will also have another and equally important effect — that of raising still higher the 
already great reputation of Dr. Cullen himself. During the latter part of the life, 
and for some time after the death of that illustrious professor, his authority stood 
higher than that of any other physician, either in Great Britain, or on the con- 
tinent. His writings were in the hands of every physician, in the original or in 
translations; — his doctrines were received and commented upon by teachers^ 
students, and practitioners, as the only true and philosophical ones; and his First 
Lines, his Nosological Synopsis, and his Lectures on the materia medica were 
considered as indicating the accurate and extensive clinical knowledge of their 
author, and as the best possible guides for practising physicians. But time, 
which operates so many changes, did not spare the reputation of Dr. Cullen. 
His doctrine gradually, and very naturally gave way to others based upon the 
discoveries made since his time; and for many years his works have been super- 
seded by others of a later date, and presenting a view of the improved state of 
physiological and pathological sciences. We do not think we exaggerate, 
when we say, that on the continent and in this country, they are now princi- 
pally considered as objects of literary curiosity by the inquiring student; that 
the authority of their author on theory and practice has insensibly been re- 



192 Bibliographical Notices. 

placed by that of more modern leaders, that the services he has rendered to 
the science of medicine have ceased to be as highly prized as they were for- 
merly, and that there are not wanting those who regard him as little better 
than a theorist. The present work, however, presents in a much more fa- 
vourable light, than had been before done, the merits of Dr. Cullen, and 
will probably occasion a change of sentiment in his behalf. "We confess that 
for ourselves, a perusal of its contents has made us feel much more disposed 
than we had heretofore been to coincide with those who regard him as 
eminently distinguished for the accuracy of his powers of observation, for 
the acuteness of his discrimination, for the soundness of his judgment, for the 
comprehensiveness of his genius, and for the indefatigableness of his diligence 
" in collecting materials for the operation of his intellect." 

Dr. Cullen was the second son of William Cullen, an Attorney of the Parish 
of Bothwell, and the factor to the Duke of Hamilton. He was born at 
Hamilton, a small town on the Clyde, about ten miles above Glasgow, on the 
15th of April, 1710. After obtaining the rudiments of his literary education at 
the Grammar School of Hamilton, he was sent to prosecute his studies at the 
University of Glasgow. On commencing his medical studies, Dr. C. was bound 
apprentice to Mr. John Paisley, of Glasgow, and received from that gentleman, 
then engaged in extensive practice in that city, his early professional instruc- 
tion. He remained two years with Mr. Paisley, and in 1729 proceeded to Lon- 
don, where he embarked in the character of surgeon on board of a merchant 
vessel, bound for the West Indies and Spanish America. After an absence of 
about eighteen months, six of which he spent at Porto-Bello, he returned to 
England, and entered the shop of Mr. Murray, an apothecary of London, with 
the view to prosecute the study of pharmacy and materia medica. In 1731, or 
1732, he returned to Scotland to arrange some domestic matters, and resided 
two years in the family of a relative, where he spent his leisure time in assidu- 
ous application to his medical studies. In 1734-5 and the subsequent years we 
find him at Edinburgh, attending the lectures of Monro, (the first,) St. Clair^ 
Rutherford, Innes, Plummer, and Alston, who then occupied the various chairs 
in the school of that city. During this time, Dr. Cullen formed an association 
with some of his fellow students, for the purpose of discussing such questions 
as the course of their studies suggested. This association soon grew in impor- 
tance, and was the origin of the Medical Society of Edinburgh, an institution 
which continues to this day to flourish, and is said to have exercised on the 
progress of medical science in Great Britain, an influence perhaps superior in 
many respects to that of the school itself. 

In 1736 Dr. Cullen commenced the practical duties of his profession as sur- 
geon in his native town, and soon obtained the confidence of the principal inr 
habitants, and of the Duke of Hamilton himself, whom he attended in an alarm- 
ing fit of illness. While residing in Hamilton, Dr. Cullen became the friend and 
medical preceptor of the late Dr. William Hunter— 

""Whose disposition, genius, and love of study were everyway congenial 
with his own. Their intercourse soon gave rise to a friendship that continued 
uninterrupted till the death of Dr. Hunter in the year 1783." 

During his residence in Hamilton Dr. Cullen was twice elected a magistrate 
of that place, first in the year 1738, and again in 1739, in conjunction with a 



Thomson's Life and Writings of Cullen. 193 

relation of his own, Mr. Hamilton of Fairholm, and took an active share in the 
agricultural improvements beginning at that time to be introduced into the 
west of Scotland. He married in 1741 Anna Johnstone, daughter of the Rever- 
end Mr. Johnstone, Minister of Kilbarchan, in the county of Renfrew; and con- 
tinued to practice as a physician in Hamilton till the autumn of 1744, when he 
removed, with his family, to Glasgow. Here he formed the intention of teach- 
ing some branch of medical science by lectures. In 1744-5 he delivered a 
course, as appears from a letter from Dr. Hunter, and soon after entered into 
an arrangement with Dr. Johnstone, the professor of medicine in the university 
of that city, by which he was enabled, during the winter of 1746, to deliver a 
course of lectures on the theory and practice of medicine. Dr. Cullen also gave 
lectures on materia medica, botany and chemistry. 

"In the physic class," says Dr. Wallace in a letter to Dr. Thomson, "he 
never read lectures but only used notes; in the chemistry he sometimes read, 
but very seldom. To medical students, as a short text book, he gave out oc- 
casionally a manuscript half sheet, to be copied and circulated from one to 
another." 

He appears at once to have abandoned the system of Boerhaave, whose in- 
stitutions and aphorisms were then very generally employed as text books in 
the different medical schools of Europe; traced a course of instruction founded 
on personal knowledge of the subject, and delivered the same opinions with 
regard to the theory of fever, the humoral pathology and the nervous system, 
which have since appeared in his writings. 

" In entering upon the duties of a teacher of medicine, Dr. Cullen ventured 
to make another change in the established work of instruction, by laying aside 
the use of the Latin language in the composition and delivery of his lectures. 
This was considered by many as a rash innovation; and some desirous to de- 
tract from his reputation, or not sufficiently aware of the advantages attending 
this deviation from established practice, have insinuated that it was owing to 
Dr. Cullen's imperfect knowledge of the Latin that he was induced to employ 
the English language. But how entirely groundless such an insinuation is, 
must be apparent to every one at all acquainted with his early education, 
course of studies and habits of persevering industry." 

Though Dr. Cullen was thus engaged in delivering lectures in the medical 
school of Glasgow, he was merely as a permitted teacher — not as a regular pro- 
fessor. In 1751 he received the appointment to the chair of medicine, through 
the influence of Archibald, Duke of Argyle, to whom he had been introduced 
a few years before. Dr. Cullen fulfilled the duties of that station until the year 
1755. But at length harassed by an extensive and laborious but unprofitable 
practice, which deprived him of leisure for the successful cultivation of science, 
he became a candidate with Dr. Francis Home and Dr. Black for the chair of 
chemistry in the University of Edinburgh, and obtained the situation of joint 
professor with Dr. Plummer, after whose death he became sole professor. In 
1757 Dr. Cullen undertook to deliver clinical lectures — a task in which he was 
aided by Dr. Whytt and Monro. 

"Dr. Cullen possessed in a remarkable degree the qualifications necessary 
for a clinical teacher. To a minute and extensive knowledge of all the auxiliary 
branches of medicine, and to the great experience which he had acquired by 
private practice, he added a peculiar talent for the observation and accurate 



1 94 Bibliographical Notices. 

description of diseases, accompanied with a strong desire, and the ready power 
of communicating- his knowledge in the most interesting manner to his pupils. 
During the whole of the eighteen years that he was occupied in lecturing on 
clinical medicine in the Royal Infirmary, he bestowed much time and most un- 
common pains on the proper performance of that duty. Of the notes from which 
he spoke his clinical lectures, those of the first five years and of the eighth 
year have by some accident been lost; but those of the other twelve years have 
been preserved. In these notes, constant reference is made to the case-books 
and the daily reports of his patients, showing how closely he followed, and 
what use he made of these in his lectures. Besides having the histories of the 
cases of his clinical patients carefully drawn out by his assistants, and giving 
himself daily reports of their progress, and of the medicines prescribed, (all of 
which, conformably with the practice of the hospital, were inserted into journals 
open for the inspection of his students,) it appears from his manuscript clinical 
lectures that he was accustomed to write down, previously to lecturing, full 
notes of all those particulars respecting each individual case, the symptoms of 
the disease, its diagnosis, prognosis, and probable causes, and the effects pro- 
duced upon it by the remedies employed, which appeared to him to require 
or deserve attention; together with an account of the morbid appearances ob- 
served after death in those cases which had a fatal termination; in short, to take 
notice of every circumstance which could tend in any way to awaken the ob- 
servation, and to extend the practical knowledge of his students. Even his 
mistakes and errors in practice, as well as his skill and success,. Dr. Cullen never 
failed to render available to these purposes." — Pp. 107, 108. 

" Besides possessing high qualifications as a clinical lecturer, Dr. Cullen had 
the strongest motives to employ all the powers of his mind in this new field cf 
professional exertion. His lectures on clinical medicine afforded the most fa- 
vourable opportunity that could be desired of exhibiting publicly in Edin- 
burgh his talents as a teacher of medicine, of evincing his skill and experience 
as a practical physician, and of establishing by those means a claim to the chair 
of the practice of physic, when it should become vacant by the resignation or 
demise of his colleague Dr. Rutherford. 

" Endowed with these qualifications, and animated by these motives, Dr. 
Cullen speedily obtained great reputation as a teacher of clinical medicine, ac- 
quired the esteem and admiration of his students, and gained by his attention 
and kind manners the universal confidence of his patients. His lectures were 
distinguished by that simplicity, ingenuity, and comprehensiveness of view, 
which marked at all times the philosophical turn of his mind; and, as I have 
been informed by several eminent medical men who had an opportunity of at- 
tending them, and more particularly by one who acted as his clinical clerk in 
1765,* were delivered with that clearness and copiousness of illustration with 
which in his lectures he ever instructed and delighted his auditors. It is to be 
regretted that the benefits of Dr. Cullen's clinical experience were for many 
years in a great measure confined to his own students; and that, from his other 
engagements and pursuits, he was prevented from giving the results of this ex- 
perience in a more direct manner than that in which we now possess it in his 
works on Nosology, Materia Medica, and the Practice of Physic. Had these 
results been presented to the public in the form of clinical reports, like those 
of his contemporary De Haen, it is impossible that the erroneous assertion so 
often ignorantly repeated of Dr. Cullen's being merely a speculative teacher of 
practical medicine, could ever for a moment have been entertained by the 
foreign medical public. No teacher of practical medicine, as I shall have fre- 
quent occasion to show in the course of this narrative, was ever at more pains 
than Dr. Cullen to distinguish between well ascertained matters of fact and the 
assumptions and conclusions of hypothetical reasoning. In leading his students 
to reflect and to reason, it was his constant endeaveur to teach them to observe 

* " The late Dr. John Fleming', long- a Memher of the Medical Board of Calcutta." 



Thomson's Life and Writings of Cullen. 195 

the course of nature in diseases, to discriminate between their uniform and es* 
sential symptoms and their merely accidental combinations, and to ascertain^ 
as far as is possible by observation and analytical reasoning-, the respective in- 
fluence of the remedies employed by art, and of the operations of nature in the 
cure of diseases.' 1 — Pp. 109-111. 

On the death of Dr. Alston, the professor of materia medica, in 1760, shortly 
after that gentleman had commenced his lectures for the season, Dr. Cullen 
was petitioned by the students to undertake the duty of the chair. He readily 
complied with this request, and thereby had a new opportunity of evincing- to 
the public the great extent of his medical knowledge and his power as a teacher. 
The lectures which he delivered on the occasion, excited a degree of interest 
that had seldom, if ever been produced by any other course on that subject. 
This was shown, Dr. T. remarks, not only by the applause they received from 
those who heard them, but also by the eager curiosity with which manuscript 
notes taken by his students were long sought for, multiplied and circulated 
amongst the medical profession in Europe. 

'* It must have been in some measure to gratify this curiosity, that ten years 
after the period at which they were delivered, an incorrect edition of these 
lectures was, without Dr. Cullen's knowledge, published in London from the 
manuscript notes of some of his pupils; and not only translated into several of 
the languages of the continent, but republished in Dublin and in Edinburgh. 
The unwarrantable liberty which had been taken by the publication of his lec- 
tures, induced Dr. Cullen to apply to the court of chancery for an injunction 
to stop their sale; which was immediately granted." " As on inquiry, it ap- 
peared that the physician who had furnished the bookseller with the manuscript 
of the lectures was sensible of the error he had committed, and had had no pe- 
cuniary object in view by their publication, and as a considerable number of 
printed copies had already got into circulation, Dr. Cullen at length agreed to 
allow of the sale of the remaining copies on condition that he should receive a * 
share of the profits, and that the grosser errors in the work should be corrected 
by the addition of a supplement." "But though on this occasion a great injury 
Was done to Dr. Cullen's feelings, there was apparently none intended, and 
there certainly happened none by it to his professional reputation." 

Great efforts were made by the friends of Dr. Cullen to induce Dr. Ruther- 
ford, the Professor of the Practice of Physic, then in advanced years and in de- 
clined health, to resign in his favour. But owing to the prejudices which that 
gentleman had imbibed against Dr. Cullen, those efforts were unavailing; and 
in 1766 Dr. Rutherford resigned in favour of Dr. John Gregory, who had held 
for several years the same office in King's College, Aberdeen, and who, though 
younger and less experienced as a teacher than Dr. Cullen, was still very justly 
considered as a physician of great learning and unquestionable talents. Dr. G. 
was immediately elected to that chair. 

On the death of Dr. Whytt, which took place about two months after the 
election of Dr. Gregory, the vacancy thus caused in the chair of the Theory of 
Medicine was attempted by some of Dr. Cullen's friends, to be filled by the 
transfer of Dr. Gregory to that professorship, an arrangement which would have 
enabled them to place Dr. Cullen in the chair of the Practice. This arrange- 
ment however appears to have failed from the unwillingness of Dr. Gregory to 
become a candidate for the theoretical chair. Dr. Cullen and his friends had, 
it appears, been made to believe that the purpose of choosing Dr. Gregory as 



196 Bibliographical Notices, 

the successor of Rutherford, was to remove the objection made by him to 
Dr. C. and that the chair would be given to Dr. Cullen as soon as Dr. Gregory 
should be otherwise provided for. Their disappointment in relation to the 
failure of their efforts on this affair was in consequence extreme, and Dr. Cul- 
len was with difficulty prevailed upon to accept the chair of the Theory of 
Physic. This, however, he at length consented to do, rather in compliance 
with the wishes of his friends, and in order to give the electors an opportunity 
of bringing Dr. Black into Edinburgh, than from any desire of his own to oc- 
cupy that situation. He was accordingly elected to that office, and admitted 
Professor of the Institutes or Theory of Medicine on the 1st of November, 1766? 
and on the same day Dr. Black was admitted into the University as his succes- 
sor in the Professorship of Chemistry. 

An address was presented to the patrons of the university, signed by one 
hundred and sixty students, suggesting the propriety of a translation of Dr. 
Cullen to the chair of practice. This having failed, another address signed by 
one hundred and fifty-one students, was presented for the purpose of urging the 
propriety of electing Dr. Cullen and Dr. Gregory conjointly and severally Pro- 
fessors both of the Theory and Practice of Medicine. The proposal was at 
length adopted, and Dr. Gregory, after delivering three courses of lectures on 
the practice of physic, during the winter session of 1766-7, 1767-8, and 1768-9, 
was at length induced to comply with the general wish of those interested in 
the prosperity of the university, that Dr. Cullen should be permitted to lecture 
upon that subject. Accordingly we find that he delivered a short course of 
lectures on the practice of physic, in the summer of 1768, and — 

" During the remainder of Dr. Gregory's life, Dr. Cullen and Gregory con- 
tinued to give alternate courses of the theory and practice of physic. On Dr. 
Gregory's death, which happened on the 10th of February, 1773, Dr. Cullen 
was appointed sole Professor of the Practice of Physic." " Such were the dif- 
ficulties to be overcome, and such the exertions required to procure, first a 
place in the University of Edinburgh, and afterwards the proper situation in it, 
for the man whose genius, talents, and industry shed such a lustre over the 
institution, and contributed in so remarkable a degree to extend, and to per- 
petuate the fame of its medical school." 

Dr. Thomson has devoted a very considerable portion of the volume before 
us to an examination of the three great systems of physic prevailing in the 
medical schools of Europe at the period when Dr. Cullen first began to deliver 
lectures on medicine at Glasgow — those of Stall, Hoffmann, and Boerhaave, as 
well as of the peculiar theories of Glisson, Haller, and Whytt. After doing this, he 
offers a very full account of the doctrines taught by Dr. Cullen, accompanied 
with copious extracts from his unpublished lectures and other writings. We 
are precluded by our limits from following the learned biographer into details, 
and must content ourselves with a few words on that part of his work relating 
to Dr. Cullen. 

The author remarks, that Dr. Cullen in succeeding to the chair that had been so 
ably filled by his colleague, Dr. Whytt, entered on the duty of teaching the Insti- 
tutions of medicine with a reputation which it required the fullest exertion of 
his talents to support. To an intimate acquaintance with the theoretical and 
practical writings of his predecessors and contemporaries, he was known to unite 
a vigorous and discriminating understanding, matured by long continued obser- 



Thomson's Life and Writings of Cullen. 19? 

Vation and experience, with the most felicitous powers of exciting- the curiosity 
and directing the pursuits and studies of his pupils. 

"The success with which he taught the Institutions of medicine during- the 
time he held that chair> redounded so much to the honour of the university and 
to his own fame, that his friends and admirers had ultimately more reason to 
rejoice at, than to regret the temporary disappointment he had experienced in 
not obtaining the chair of the practice of physic, which had been so long the 
object of his ambition." 

He arranged the subjects of which he had occasion to treat in those lectures 
under the three general divisions of physiology, pathology, and therapeutics, 
comprehending the consideration of health, diseases, and remedy. In explain- 
ing the general objects of his course, he observed that the practice of physic 
is the art applied to particular diseases and cases, but that before considering 
this art in its application to particular diseases, certain general doctrines are 
necessary to be premised, which are called the Institutions of medicine. Some, 
he remarks, are pleased to call our present course the theory of physic. 

"With regard to the common notion affixed to the term theory, I must say- 
that I mean to deliver nothing in this course but what is applicable to the cure 
of diseases, which is the ultimate end of all our studies; what we are to deliver 
in this course will be applicable to practice." 

" When gentlemen," he adds, "call this a course of theory, if they mean 
by that term a deduction of reasoning, and that founded upon hypothesis, we 
refuse the application; but if by theory they mean the general doctrines of the 
art of medicine, founded upon experience and observation, I allow you to call 
this the theory of physic. My general doctrines are to be so many general 
facts." 

In thus upholding the necessity of general principles, affording a more cor* 
Feet definition of the term theory than is generally adopted, and establishing a 
distinction between that word and hypothesis, with which it is but too often 
confounded, Dr. Cullen advocated the same views which have been entertained 
by Sir Isaac Newton, Adam Smith, d'Alembert, Playfair, Dugald Stewart, and 
others, and helped to remove the vulgar prejudices which prevailed, and con* 
tinue to a certain extent to prevail, even among medical men, in relation to the 
former of these terms. 

Dr. Cullen divided the physiological part of his course into seven sections — * 
the first comprehended an account of the general facts known with regard to 
the solid matter of which every organ of the body consists; the second, an ac* 
count of the nervous system; the third, of the motion and circulation of the 
blood; the fourth, of the functions employed in supporting and repairing the 
several solid and fluid parts of the body; the fifth, of the organs employed in 
receiving and modifying the impressions of external bodies necessary to sensa* 
tion; the sixth, of the motions of the several parts of the body which depend 
upon the action of muscles; and the seventh, of the functions peculiar to the 
sexes. 

The most important and interesting portion of Dr. C.'s lectures on the theory 
of medicine, judging from his printed works on that subject, and from the ex* 
tracts from his unpublished writings contained in the volume before us, is doubt- 
less that relating to the doctrine of the functions and properties of the nervous 
system. 

No. XXV.— Nov. 1833* 18 



1 98 Bibliographical Notices. 

In combining, as Dr. Thomson remarks, the information relative to the ner- 
vous system, contained in the writing's of his contemporaries, Haller, Wbytt, 
and Gaubius, with the opinions which he had early adopted from the works of 
Hoffmann, Dr. Cullen seems to have constantly endeavoured to extend, im- 
prove, and methodize his knowledge of the functions of this system, and cer- 
tainly in no part of his labours do the power of his mind appear to have been 
more successfully exerted. His speculations with regard to the different func- 
tions of that system, but more particularly with regard to that of the animal 
power or energy of the brain, were incorporated with every opinion which he 
taught concerning the phenomena of the animal economy, the causes of dis- 
eases, and the operation of medicine. They may be said to constitute a most 
important part, if not the sole basis, of that system of the practice of physic, 
which he made the subject of prelection, as well as of study, for a period of 
nearly forty years before he ventured to give it to the public. Of this division 
Dr. Thomson has given a very clear, methodical and detailed exposition — re- 
marking that the general results of Dr. C.'s speculations upon this subject may 
be comprehended under the following heads: — 1st. Of the nervous system con- 
sidered as the connecting medium between the soul and body, or the immate- 
rial and the material parts of man. 2d. Of the nervous system considered as the 
organ of sensation. 3d. As the organ of our intellectual operations, memory 
and judgment. 4th. As the organ of the voluntary, involuntary, mixed, and 
sympathetic motions of the animal economy. 5th. Of the different conditions 
of the nervous system in the states of sleeping and walking, and the doctrine 
of excitement and collapse. 6th, and lastly. The effects of custom upon our 
corporeal and mental functions. 

It is impossible to give, in the narrow space allowed us, an analysis of Dr. Cul- 
len's views on these various subjects, as they are presented by his biographer. 
Indeed, even could we command room we should not feel disposed to under- 
take the task, because in the volume before us, we find, not the lectures them- 
selves, but an analytical exposition of them; and because, nothing being less 
easy than to offer an intelligible abridgment of an abstract, it would be beyond 
our power to compress Dr. Thomson's analysis to the degree that would be re- 
quired for our purposes, and at the same time preserve the interest it excites when 
perused in its present form. Nevertheless, as Dr. Cullen's physiological writings 
are little read in this country, and as his views relative to the nervous system are 
not well known or sufficiently attended to, we shall offer no apology for subjoin- 
ing a few extracts and remarks in illustration of some portions of his doctrine. 

Dr. Thomson states that in considering mind and matter as respectively en- 
dowed with qualities essentially different, Dr. Cullen regarded the nervous sys- 
tem as the connecting medium between the mind, or immaterial thinking part 
of man, and the different organs of which his body is composed. But in expres- 
sing his opinions upon these subjects, he was particularly careful to guard him- 
self from the charge of materialism. He observed, that in addition to the argu- 
ments by which Dr. Whytt has refuted that doctrine, the association of ideas — 
a very fundamental part of our intellectual operations, cannot be explained 
upon any supposed organization of matter. 

Dr. Cullen held that our sensations may be divided into two kinds: — 1st. Sen- 
sations which arise from the impulse or impression of external bodies, which he 



Thomson's Lift and Writings of Cullen. 199 

therefore names sensations of impression. 2d. Those which arise from the 
mind's being conscious of its own actions, and of the motions which it excites. 
These he named sensations of consciousness. This last was, he remarks, a new 
term in physiology; and it must be allowed, as Dr. Thomson states, that some 
such term was necessary, in order to comprehend under it a variety of feelings 
of the mind of which we are conscious, but which we are not able to trace to 
the impression of bodies external to the nervous system. 

"The sensations of consciousness," Dr. Cullen remarks, "may be referred 
to the following heads. 1st. Those of apperception, by which we are in general 
conscious of perceiving, remembering, judging, and willing, and thereby of 
our existence and identity. 2d. The sensations arising from the particular state 
of thinking, according as perception, memory and judgment are more or less 
clear, ready, or exact. 3d. The sensations arising from the particular state 
of volition, and its various modes. 4th. The sensations arising from the general 
state of the muscular action, as vigorous or weak, easy or difficult." "5th. 
The sensations arising from particular actions, or a consciousness of the actions 
excited, and of the motion of the different parts of the body. These also pro- 
bably take place with regard to all the internal functions/' " 6th. The sensa- 
tions arising from the diminution or absence of impressions. I will not say, 
he observes, that darkness is visible, but it is a positive sensation. The sensa- 
tion of darkness or blackness is the absence of impression; it takes place when 
no rays of light fall on our eyes, so that the sensation of consciousness may be 
here separated from that of impression." 

Dr. Cullen's observations on the properties of the solid matter of which every 
organ of the body consists, certainly evinces, as Dr. Thomson observes, great 
knowledge and ingenuity; but the manner of considering this subject has of 
late years been so completely changed by the discovery of the constituent parts 
of animal matter, and by the more accurate examination of the chemical and 
physical properties of each of the solid parts, as to render it now as unnecessary 
as it would be uninteresting to detail his particular opinions upon the subject. 

"It may be remarked, however, that he was aware that all animal matters 
may be ultimately traced to a vegetable origin; and he observes that, if we 
would inquire into the production of animal matter, we must first inquire in 
what manner vegetable matter may be converted into animal." 

He regarded the moving or muscular fibres, as a continuation of the medullary 
substance and nerves, and therefore termed them the moving extremities of the 
nerves. He supported the same opinion as Haller respecting the identity of 
the sensory and motor nerves; and maintained that we must either allow these 
nerves to be the same, or suppose that there is no where a nerve of motion 
which is not accompanied with a nerve of sense that is inseparable from it. This 
objection, as our readers undoubtedly know, has no weight now; experiments 
having shown, that what Dr. Cullen held in the light of a gratuitous supposi- 
tion, must be viewed as an incontrovertible fact. He rejected the hypothesis 
of the communication of motions through the different parts of the nervous sys- 
tem by means of vibrations of the nerves, or of a fluid secreted in the brain. 
Nevertheless he conceived with Hoffmann and others, that the agency of some 
subtile fluid in this system is necessary, in order to fit it for the communication 
of impressions from one part to another. This fluid he termed the nervous fluid i 
but without meaning, as he himself informs us, to determine any thing with re- 
gard to its source, nature, or manner of acting. Though he conceived the mus? 



200 Bibliographical Notices. 

cular fibres to be a portion of the nervous system, he was disposed to attribute the 
power of contractility which they possess, and which, he observed, is not pos- 
sessed by any other portion of this system, to some peculiarity of their organi- 
zation, without professing- to explain in what this peculiarity consists, and on 
what physical change in the condition of muscular fibres, their contraction 
depends. 

Dr. Thomson remarks, that though Dr. Cullen acknowledged it to be possible 
that the property of irritability may, as Haller and others had believed, reside 
entirely in the muscular fibre itself, independently of any influence derived 
from the nervous system, yet he maintained that in the production of all the vo- 
luntary, involuntary, and mixed motions of the animal economy, the muscular 
fibre is always more or less influenced by an energy derived from the nervous 
system. 

" The vigour of the inherent or contractile power of the muscles," Dr. Cul- 
len observes, "cannot be evident in a living animal, because we cannot be cer- 
tain of its acting entirely without the nervous power; and, with regard to the 
strength with which a muscle contracts, I cannot undertake to show that, in 
different conditions of the body, as it is weakened by disease or by various other 
causes, or as it is increased by powers which have that effect, this contraction 
will be perceived to be manifestly different; and I shall have many occasions to 
prove that the tone of the inherent power is increased or diminished by causes 
acting upon the brain, and upon the brain alone." 

To this influence of the nervous system upon the muscular, involuntary as 
well as voluntary, he gave the name of the animal power or energy of the brain. 
This term, he observes, has not been common in our systems of physic; but if, 
in all the communications that take place between the different parts of the 
body, much depends upon the present state of the brain, we will not be in any 
difficulty in lodging a particular power there, of which we shall speak under 
the name of animal power, or energy of the brain. 

"This animal power we suppose to be seated in the brain, and only there 
seated. Whether you consider it, as Dr. Whytt did, as a sentient principle, or 
as automatic vital energy, depending upon the peculiar organization of all the 
several parts of the nervous system, it is probably the fundamental part of the 
system without which the functions cannot long remain." 

In reference to the theory of sleeping and waking which teaches that in the 
latter state the animal spirits are gradually exhausted, whilst during sleep, on 
the other hand, they are recruited, Dr. Cullen observed, that it is embarrassed 
with many difficulties. He endeavoured to account for the alternate exercise 
and suspension of sense and motion, which occur in the two states in ques- 
tion, by an increased or diminished mobility, or a more or less excited state of 
the ethereal medium which Sir Isaac Newton had suggested as the cause of the 
phenomena of sense a.r.d motion. But he nevertheless regarded this explana- 
tion as an hypothesis and wished it to be received as such by his students. On 
this subject he says — 

ftt l take it for granted, that when you consider the weakness and manifest 
mistakes of any other hypothesis, you will readily, with me, think that the con- 
dition of the nerves, fitting them for the communication of motion, consists in 
some state of the matter of the nervous fluid itself, and of its having more or 
less mobility; in some cases being capable of being moved with more ease and 



Thomson's Life and Writings of Cullen. 201 

vigour, while in other cases it is unfit for either. Now, I say, merely to avoid 
long expressions, I shall choose shorter ones, and shall speak of the moveable 
state of the nervous fluid, or of that condition of the nervous system which fits 
it for the communication of motion, under the term of its excitement, and a defi- 
ciency or less degree of this I shall call its collapse. Now, you must merely con- 
sider these as terms employed for what I take to be matters of fact, the increased 
or diminished force of the animal power or energy of the brain, and not as im- 
porting matters of theory, or as expressing any thing with regard to the nature 
of the nervous fluid, or wherein these different states of the nervous system 
Consist. Whatever hypotheses I may have fancied to myself, I consider these 
as hypotheses still, and dare not trust you with them, unless you take them as 
they pass in my mind, and be very certain never to apply them in particular 
cases.* 

" ' I have been a little at a loss,' he observes, 'in the application of the terms 
of excitement and collapse. There is nothing more manifest than that the de- 
gree of excitement is very different upon different occasions; if we take the 
lowest, every higher degree than that must be called a degree of excitement; 
and if we take the highest degrees, and consider the lower degrees that may 
take place while life still subsists, every lower may be called a degree of col- 
lapse. The same ambiguity occurs with regard to the terms of heat and cold, 
which may be absolutely applied to the same individual state of bodies; and 
philosophers have not yet agreed where they should begin with applying the 
terms heat and cold; and so it may be with regard to the terms excitement and 
collapse. In saying that, in the ordinary state of waking men of health, the ex- 
citement is total with respect to the functions of the brain, but readily admits of 
diminution so as to produce the state of sleep, I mean,' continues Dr. Cullen, 
« to settle the matter a little more exactly. I would call those states, states of 
excitement, where the excitement is total with regard to the functions of the 
brain, where there is in every part the general exercise of sense and volition. 
I know that there are many cases where there is a mixture of the excitement 
and the collapse, or of the increased and diminished energy of the brain, but I 
hold that to be the state of waking and of excitement, when the whole of the 
functions of. the brain can be exercised; and, upon the contrary, whenever these 
functions are for the most part suspended, that I would call, more strictly, a 
state of collapse; and so upwards and downwards as it may occur. A degree 
of collapse, or diminished energy of the brain, takes place in the case of natural 
sleep; we call it a state of collapse when the excitement is partial, when the 
collapse prevails so far as to suspend very entirely the exercise of the functions 
of sense and volition, so that such a collapse takes place in sleep as is sufficient 
to weaken the general activity of the brain.' 

"In extending his application of the doctrine of excitement and collapse to 
the morbid phenomena of the animal economy, Dr. Cullen made choice of ma- 
nia and syncope, as two affections calculated to illustrate his opinions respect- 
ing these opposite states of strength and weakness, vigour and debility, sthenia 
and asthenia of the nervous system; the first, mania, being an example of a di&- 
ease in which the excitement is increased above the natural standard; and the 
second, syncope, of one in which the excitement is reduced below that stand- 
ard, or in which a degree of the state of collapse or diminished energy of the 
brain takes place." pp. 310-314. 

Dr. Cullen was led to apply to the nervous system the terms excitement and 
excitability by a species of analogy derived from the theory of electricity, and 
the example of bodies in which electricity could be excited and accumulated; 
conceiving that the nervous fluidjnight, during life, be capable of excitation 
and discharge or exhaustion. This was perhaps suggested to him by the at- 
tempt which Sauvage had made to establish an analogy or identity between the 
supposed nervous fluid and electricity. 

18* 



202 Bibliographical Notices. 

"Indeed Dr. Cullen himself, in assigning his reasons for believing that the 
motion exerted m the sentient extremity of a nerve in the process of sensation, 
must be of the oscillatory or vibratory kind, suggests that it may somehow de- 
pend upon an electric tremor." 

The term collapse, Dr. Thomson thinks, was probably derived by Dr. Cullen 
from Boerhaave, who, in stating what he conceived to be the proximate cause 
of sleep, says, that in so far as the solids are concerned, it is the compression 
or collapse of the smallest vessels of the brain, in consequence of which they 
cannot transmit their fluids. 

The preceding details will be read with interest as conveying a correct idea 
of that part of the doctrine of Dr. Cullen, which has always been regarded as 
constituting one of its most remarkable features, and has been designated by 
continental writers under the appellation of the theory of excitement. 

We have already dwelt so long on the physiological views of Dr. Cullen, 
that we have not sufficient space left for an exposition of his pathological doc- 
trine. But we cannot refrain from presenting here a few details explanatory of 
his opinion relative to proximate causes, or morbid states, and to the diseases of 
the fluids. Proximate causes, according to him, are generally compound, con- 
sisting of different conditions in different parts of the animal economy, which 
all concur together in the case of actual diseases as they affect individuals. In 
a course of lectures on the practice of physic, proximate causes may be consi- 
dered in this concurrence; but in pathology they must be taken separately. 
Such a consideration has given what pathologists have called the morbi simpli- 
clores. As the proximate cause of a disease, he remarks, may consist in a fault 
either in the solid or in the fluid parts of the body, the diseased states are di- 
vided into those of the solids, and those of the fluids. The diseases of the so- 
lids are of two kinds; those of the solids as they are in common to the whole of 
the body, and those of the same solids as formed into various organic parts. 
This gives again what may be considered as the morbi solidi simplicis, and the 
morbi organici. Dr. Cullen considered it as a well-established fact that the fluids 
have a share in the performance of the natural functions and that their devia- 
tions have a share in disease. The vitia fluidorum, he adds, are therefore, 
agreeably to both ancient and moderns, properly considered in a general patho- 
logy, as proximate causes of diseases. 

"But diseases properly consist in the actiones laesee, and consequently there 
may be a great many deviations in the state of the fluids, from their most healthy 
state, without diseases being produced; it is only, as Gaubius says, when the 
solids are at length affected, that they form diseases. The pathologists, there- 
fore, have been very improperly employed in considering only the affections of 
the fluids. Physicians have been accustomed so long to talk upon this subject, 
that they do not apprehend the mysteiy, as I would call it, in which it is in- 
volved; but it is still involved in a great deal of obscurity, and I think I cannot 
do better than to consider the subject as it lies in Gaubius, under the two heads 
of morbi humorum absoluti and morbi humorum relativi, the former comprehend- 
ing changes in the coherence of the fluids, their vitiated qualities, and the vi- 
tiated states of the secretions; the latter changes in the quantity, in the place, 
and in the motion of the fluids. In commenting on Gaubius's divisions, I shall 
often have more to object to than to illustrate, but I could not attempt a sys- 
tem for myself, and it is to be presumed that Dr. Gaubius, who is a man of un- 
common discernment and great erudition, has put the matter in as clear a light 



Conolly on Insanity. 203 

as is possible, and that in considering what he has written, we shall see at least 
the present state of our knowledge on this subject." p. 341. 

In reading these and other extracts from his lectures on physiology, patho- 
logy, and therapeutics, contained in the volume before us, it is impossible to 
refuse admitting that Dr. Cullen possessed a very uncommon share of sagacity, 
originality, and ingenuity, combined with energy and soundness of judgment, 
and great learning. 

" The imperfections of Cullen," as is remarked by judicious writers, " were the 
imperfections of the period in which he lived, and of the science itself, which it 
was his delight to cultivate; and if we are now in a situation to discover the 
blemishes of this luminary of medicine, it is chiefly by means of the refulgence 
which his genius has reflected on every object that lay within his range." 

His doctrines, physiological and pathological, were soon adopted with more 
or less modifications and acknowledgment by almost all the physicians of Scot- 
land and England, as well as by many continental writers; and it does not re- 
quire much trouble to find, that most of the doctrines which have occupied the 
attention of the medical world since his times, those of Berlinghieri, Borsieri, 
Stoll, Blumenbach, Sprengel, Reil, Bichat, Pinel, &c. are greatly indebted to 
the views contained in his writings and developed in his lectures. It may be 
remarked also that M. De la Roche, in his dialysis of the Functions of the Ner- 
vous System, a work which excited considerable sensation in Europe, repro- 
duced all the essential doctrines of Cullen on this subject, as a system of his own. 

As we have already stated, the second volume of Dr. Thomson's work, which 
will present a continuation of the biographical details of Dr. Cullen, as well as 
an account of the publication of the first lines, and nosology, has not as yet made 
its appearance. The profession is, indeed, greatly indebted to Dr. T. for the 
very full, interesting, and valuable exposition he has given of the doctrine of 
Dr. Cullen, and for the history of the progress of medical science during the 
life of that eminent professor. No one was better qualified than Dr. T. for 
the performance of that difficult task, and those who peruse the work will we 
are sure cheerfully admit that he has done it the amplest justice. L. 



XIV. Jin Inquiry concerning the Indications of Insanity, with suggestions for the 
better Protection and Care of the Insane. By John Conollt, M. D. Professor 
of Medicine in the University of London. London, 1830. pp. 496. 

Dr. Conolly devotes his volume, as may be gathered from the above title, not 
to the general pathology and treatment of insanity, but merely to its diagnos'19 — 
to the means by which the practitioner discriminates the deranged from the 
sane mind, and decides upon the momentous question of liberty, with civil and 
social responsibility, or of coercion and a cell. Unquestionably this inquiry is 
fraught with a deep and painful interest — it is one of those in which society 
holds the deepest stake, and feels the most excited and laudable curiosity. Dr. 
Conolly had, at the period of his publication, devoted a share of his attention 
to this subject for many years, and for five of them had held the appointment 
of Inspecting Physician to the Lunatic Houses for the County of Warwick. He 
therefore, appears before us supported not only by his general reputation, but 



204 Bibliographical Notices. 

by the authority derived from some experience. And yet the volume, though 
abounding 1 in profound reflection, acute remark, and much soundness of com- 
ment and originality of suggestion, does not, upon the whole, assume in our 
eyes the air of long and extensive experience. Dr. Conolly has been an in- 
specting, and not an attending physician; and the marks of this character ap- 
pear to us to be visible in many parts of his book. They exhibit themselves, 
we apprehend, in a greater facility of stating difficulties than of pointing out 
the best methods of vanquishing them — he seems rather to manifest a willing- 
ness to enact and express rules and make demands, than to feel himself in the 
light of one of the humble executive who are to benefit by the criticisms, and 
comply with the requisitions. 

In Chapters I. and II. and in many other parts of the volume, Dr. Conolly en- 
larges with much eloquence upon the great importance of the certificate of a 
physician in a case of insanity, and upon the defects in practice in this particu' 
lar, which prevail in England. It is difficult to judge at this distance, of the 
extent to which his criticisms are applicable to the facts; but if, as he states, 
certificates are lightly given, in complaisance to the wishes of friends, and 
restraint and removal from the controul of property follow as a consequence, 
the more especially in a country where private mad-houses are numerous, there 
would certainly here seem to be need for a reform. Such weak and trivial 
precautions against injustice and error in a matter so important as depriving a 
citizen of his liberty, seem to us hardly consistent with the genius of the 
British common law. 

Dr. Conolly leads us into an inquiry of very considerable interest— how far 
the existence of a partial insanity justifies depriving a man of his liberty, or in 
other instances, even of the command of his property. He apprehends that a 
lunatic asylum is a very improper place for a large portion of those who are 
commonly detained in such establishments; and urges with much feeling, the 
injury done to the minds of those who retain a painful consciousness of their 
situation. Such as these have frequently expressed to him the grief they felt 
from the degradation to which they are subjected by coarse and mean atten- 
dants. They often feel heavily the sense of their own mental infirmity; and 
this is aggravated by the distressing sights which surround them, the contempt 
daily exhibited for their opinions and motives, and the privation of the company 
of their nearest and dearest relatives. These considerations are subjects of ap- 
prehension with the popular mind, and will naturally receive much attention, 
and excite the feelings of persons of sensibility. Their foundation is real, al- 
though they are perhaps exaggerated by Dr. Conolly. An experience of in- 
sanity greater than that of most men, has led us to believe that these evils, al- 
though productive of more or less injury to all who still retain sensibility and 
observation sufficient to feel their influence, are, in the majority of cases, over- 
balanced in a well-regulated asylum by the advantages of the institution. 
Among these we would class removal from old and morbid associations, absence 
from all those objects which have become interwoven with the first disordered 
feelings, freedom from that struggle for power which such unfortunate indivi- 
duals generally entertain with their friends, and from the mortification arising from 
the authorized disobedience of children and servants, regularity of hours and 



Conolly on Insanity. 205 

occupations, monotony of life, which acts as a sedative upon the mind, and 
privation of all stimulating diet and drinks, a regulation which it is almost im- 
possible to enforce in private families. 

Our object, however, is not to detail our own opinions, but to sketch those 
of Dr. Conolly, and we will therefore not make any further comment upon the 
moving and too frequently correct picture which he has given us of the miseries 
of the partially insane. Dr. Conolly apprehends that a great portion of those 
confined in mad-houses are fully capable of enjoying a large share of the com- 
forts and enjoyments of the domestic scene, even if unfitted for business, and 
that in many instances, derangement upon a single topic should by no means 
restrain them from the administration of their own affairs. We are shocked at 
the frequency with which Dr. Conolly appears to think persons are incarcerated 
in a mad-house under pretence of insanity, founded upon a mere eccentricity 
of character, in order that heirs or guardians may enjoy their property. Many 
of our readers will recollect the story alluded to in the following extract. 

" An unfortunate gentleman fancies that a Princess is in love with him— a 
very harmless fancy in itself; he wanders about the v/oods, or spends his roman- 
tic days on the banks of a river, and meditates on his passion. Surely he might 
spend his time less innocently than this! He carves the name of his beloved on 
trees; he indites moving letters to her in cherry juice. He fancies himself de- 
barred from seeing the face he adores, and thinks he is a prisoner in some 
high tower which overlooks the flood — fancies foolish enough, but certainly 
not very dangerous! He commits his letter to the guardianship of the river, 
and bids the waters 'flow on,' and ere they reach the sea, convey his written 
words to the bower of his mistress. There is nothing very criminal in all this. 
But the poor man has money, and relations who want it. Instead, therefore, 
of being allowed to become tired of his fancies, which he would be in time, 
he is waylaid, forcibly seized, carried off to a private mad-house, and inclosed 
within some dismal yard, with none but lunatics for his companions. By some 
rare accident, an opportunity is given of investigating his real state in a court 
of law; and because the suspected man will not abandon his princess, or does 
not deny the affair of the cherry juice, there arises a sound of triumph among 
his relatives, learned men felicitate themselves in having discovered what was 
so difficult to be discovered, the cause is at an end, and the foolish lover is de- 
prived of his property and his liberty, and sent back to his horrible imprison- 
ment. 5 ' p. 384, 386. 

" A man must not be made a prisoner for life because he chooses to wear a 
coat the wrong side outwards, or a painted hat. It may be more necessary to 
protect him from others than others from him; and therefore an asylum may be 
to him what its name imports — a sanctuary and a refuge; but unless Re is dis- 
posed to injure others, or himself, he must not be subjected to severe con- 
straint. If he has property, and can take care of it, no one ought to touch that 
property on account of his peculiar dress; if he has none, and can earn his live- 
lihood, no one should interfere with him, except to protect him from the per- 
secutions of others." p. 431. 

The arguments by which Dr. Conolly urges the adoption of a narrower rule 
of selection among the objects to be committed to mad-houses, are continued 
through several chapters, some of which are at the close of the work. Between 
these parts intervene a series of articles on the means by which we are to dis- 
criminate cases of insanity from those of simple eccentricity. Chapter III. is 
entitled " The Constitution of the Human Understanding." This we should 
think rather a comprehensive subject for twenty or thirty loosely printed pages. 



206 Bibliographical Notices. 

Dr. Conolly, it would seem, thinks this necessary in his country to render the 
work intelligible; and let it be remembered, that this is no catchpenny publi- 
cation, or treatise for the use of schools, but a grave and most important inquiry, 
conducted by a Professor at the time of the University of London, and affecting the 
liberty and property of English gentlemen. It ought, therefore, to be addressed 
to men of education. Notwithstanding Major Hamilton's remarks upon the defici- 
ency in this last mentioned particular, which he observed in the United States, 
we sincerely hope such a chapter will never be thought necessary in this coun- 
try; and we apprehend that most readers could fully understand Dr. Conolly's 
lucid work, without any such preliminary metaphysical instruction. Several 
chapters are occupied with the varieties of the human mind, which are pro- 
duced either by original formation, the action of various stimuli, the effects of 
disease, and the progress of age. A chapter then describes insanity, another 
more immediately discusses the duties of medical men in relation to the subject 
of discrimination, and a third and final article is composed of suggestions for the 
better protection and care of the insane. 

The favourite theory of the author, which, with the appeal against habitual 
abuses, form the two great staples of the work, is nearly as follows. The 
variety of impulse and errors of the mind, which constitute diversity of charac- 
ter, and which when exaggerated, assume the title of eccentricities, are designed 
by the author of nature to be regulated by comparison. By comparison the 
thinker discovers the fallacies which have occupied his reveries — the apparitions 
which are conjured into existence by his imagination, are seen to differ from 
real objects, or to exist under circumstances where reality is impossible; and 
hence he discovers his error, and instead of being insane, he is only a man 
imaginative, or subjected to deception of the senses. By comparison the man 
whose fits of suspicion, passion, or self-esteem approximate to insanity, disco- 
vers the disproportion between his excitement and that which ought to follow 
such a cause; and hence, although he commits the fault, he becomes aware of it, 
This principle is not very new, and perhaps some of our readers may be of opinion 
that the last application of it would include as insane more than are at present 
under medical superintendence. 

It has always appeared to us, that there is something essentially indefinite in 
the idea of insanity. Like that of disease, it consists in the derangement of 
functions; but as the regular, or so called normal performance of these functions 
is without rigorous definition, it is impossible to fix precisely what constitutes 
a deviation from it. The question partakes, and this is much to our present pur- 
pose, of the glorious uncertainty of the law. It is unanswered by any general 
expression, and is liable to constructions drawn from opinion. A magistrate is 
forbidden to exact excessive bail; but who is to determine how much bail is ex- 
cessive? The answer is made to depend upon the merits of each individual 
case, and is liable to all the usual imperfections of human intellect and human 
passions. B. H. C. 



Spencer on Asiatic Cholera. 207 

XV. An Essay on the Nature of the Epidemic, usually called Asiatic Cholera, &c. 
with the reasons why it should be regarded as an Epidemic Diarrhoea Serosa, 
instead of Common Cholera Morbus; and an Attempt to found the Treatment 
upon the Pathology of the Disease ,- being the Annual Communication to the Me- 
dical Society of the state of New York, February 5, 1833. By Thomas Spexceh, 
M. D., President: Honorary Member of the Kentucky and Philadelphia Me- 
dical Societies, Corresponding Member of the Albany Lyceum of Natural 
History, &c. Albany, 1833. 8vo. pp. 131. 

We have been much gratified with the perusal of this essay of Dr. Spencer, 
and have to regret that the press of other matter has prevented us from review- 
ing fully its contents. The author professes to have derived his conclusions 
in relation to the disease chiefly from his own clinical observations, and although 
they differ widely, in many points, from our own views, drawn from a similar 
source, we, nevertheless, cannot but view them as highly ingenious and plau- 
sible. 

Dr. S, has attempted to show that the disease under consideration is identi- 
cal in its nature and symptoms with the diarrhoea serosa of medical writers, es- 
pecially when the latter has occurred epidemically. "Whether this is admitted 
to be the case or not, is of little import, as it can lead to no very definite results in 
regard to the actual pathology of the disease: we have certainly had ample op- 
portunities for studying the phenomena of epidemic cholera, and in that manner 
of arriving at a correct knowledge of its pathology, without the necessity of re- 
sorting, with this view, to the imperfect accounts transmitted to us, of any similar 
disease, by the older writers. The term cholera, in its modern acceptation, is 
evidently a misnomer, and yet the striking similarity between the symptoms of 
the present epidemic and the disease described by the ancients under the name 
of cholera, would lead us to suspect that the latter did not employ the term to 
indicate an increased discharge of true bile, but of vitiated fluids generally. 

The essay of Dr. S. presents a tolerably accurate description of the symptoms 
by which epidemic cholera is accompanied, from its commencement until its 
termination. In a few instances, however, they are not recorded exactly in the 
order of their succession in the generality of cases, and we notice the omission 
of one or two, at least, which are almost invariably present. 

In the first, or forming stage of the disease, attended with serous diarrhoea, 
the author conceives that the symptoms depend on an increased excitability of 
the exhalant tissue (?) of the gastro-intestinal mucous membrane, by which it 
is rendered highly susceptible to the action of irritants, so that the imper- 
fectly digested food or mild laxatives often excite profuse evacuations. The 
stomach and liver are at the same time in a state of more or less torpor, so 
far at least as regards their appropriate functions. The whitish or milky ap- 
pearance of the discharges frequently noticed in this stage of the disease, Dr, 
S. attributes to the chyle not being taken up by the lacteals, and hence 
being discharged mixed with the stools. It is a fact, however, of which the 
author should have been aware, that chyle is never found excepting in the 
lacteals— the opinion which formerly prevailed that chyle was formed in the 
duodenum has been satisfactorily shown to be incorrect. 

The production of the more prominent symptoms of cholera are thus explain* 



203 Bibliographical Notices. 

ed by the author. By an irritation induced in the morbidly excitable secretory 
tissue of the intestinal mucous membrane, an augmented amount of blood is de- 
termined to the capillaries of the latter, and an increased exhalation of watery 
fluid takes place. In consequence of the great amount of fluid, containing cer- 
tain saline substances in solution, thus removed from the blood, this is rendered 
thicker and less adapted to circulate through the smaller vessels. The freedom 
of the circulation is still further crippled by the diminution in the volume 
of the blood, depriving the heart of its necessary stimulus of distention. The 
diminished mass and volume of the blood and defective action of the heart are 
the principal causes of the failure which takes place in the respiratory function 
of the lungs; which, in connexion with the want of a due amount of blood in 
the capillaries, prevents the due development of animal heat. The biliary and 
urinary secretions are suspended in consequence of a deficiency of those mate- 
rials from which the bile and urine are elaborated by the liver and kidneys; 
while the spasms of the muscles are produced by the lessened amount of arte- 
rial blood which circulates through the vessels of the brain. No accurate opi- 
nion can be formed of the correctness of these views unless the facts and argu- 
ments adduced by Dr. S. in their support are carefully studied. 

The treatment of the several stages of cholera which the author details is 
that which he has himself found most successful. In its general features it 
is unquestionably judicious. We have found, however, the lancet, but more 
especially cups to the abdomen, an important remedy in a larger number of 
cases and at a later period of the disease than those to which Dr. S. restricts 
their use. To a few of the remedies which he directs we should be inclined 
decidedly to object. 

We recommend the present essay to our readers, fully persuaded that they 
will derive instruction from it pages, even though they should not adopt en- 
tirely the pathological or therapeutical views of the author. D. F. C. 



XVI. Ji Report of the Method and Results of the Treatment for the Malignant 
Cholera, by small and frequently repeated doses of Calomel; with an Inquiry into 
the Nature and Origin of the Complaint, with a view to a more just appreciation 
of the Means for its Prevention and Cure. With numerous Illustrative Cases. 
By Joseph Ayre, M. D. Member of the Royal College of Physicians of Lon- 
don, and late Physician to the General Infirmary, — to the General Dispen- 
sary, — and to the Lying-in Charity of Hull. London, 1833. pp. 167. 

Dr. Ayre is well known in this country by his Treatise on Dropsy, and still 
better by his " Observations on the Nature and Treatment of those Derange- 
ments in the Functions of the Liver and of the other Organs of Digestion, which 
produce what are denominated Bilious Complaints," and which was republished 
here, and received with no inconsiderable degree of favour. In the present 
work the author has extended the views sustained in the last mentioned publi- 
cation to cholera. The following is a summary of Dr. Ayre's opinion respecting" 
the pathology of this disease. 

" 1st. That the cholera morbus essentially consists in an interruption, and, in 
its malignant form, in a sudden and entire cessation of the secretion of the 
liver, and primarily, as the result of it, of a congestion of the portal circle, of 



Ay re on Cholera. 209 

secretory system of veins of the liver; and, in the malignant kind, successively 
of those' veins of the abdominal viscera and vertebral column, whose venous 
circulation is associated with them. 

"2d. That the congestion of these important systems of veins becomes a 
cause of a diminution, and at length, in the malignant type of the complaint, of 
an entire suppression of the secretion of the kidneys, and of a congestion of 
the vessels of the chest, at the same time occasioning violent contractions of 
the voluntary muscles, with a disturbance in the nervous system. That from 
this state arises a great and general abeyance or collapse of the vital powers, 
and an interruption to the course of the blood through the capillary system of 
vessels, and to the changes it should undergo there; together with a loss of ani- 
mal heat, and a livid state of the surface as the results of it. 

"3d. That besides the physical interruption caused in the circulation by the 
congestion of the abdominal and hepatic, and at length of the thoracic and ver- 
tebral veins, there is an interruption given by it to those chemical changes of 
the blood, and to the expulsion from it of those noxious and excrementitial 
principles, which it is one purpose of the kidneys and liver and lungs severally 
to effect. 

" 4th. That beside the general effects in the system, the stomach and bowels 
become especially affected with a morbid irritation in their capillary system, 
which is caused in obedience to a law of the system, by which the congested 
state of the veins becomes an indirect stimulus to the arteries of the organs im- 
plicated in it. 

" 5th. That the final cause of these efforts of nature appear to be, to over- 
come the congestion; while, pending the effort, and in default of succeeding in 
it, an increased current of blood is driven into the exhalant extremities of the 
mucous surfaces of the stomach and bowels, and a copious muco-serous secre- 
tion is profusely poured out from them. 

" 6th. That in the cases where the congestion terminates spontaneously and 
favourably, it is by a renewal of the secretion of the bile, and frequently, in the 
English or common type of the complaint, by such a sudden and copious dis- 
charge of it as to occasion a copious purging and vomiting of that fluid. 

"7th. That where this remedial reaction does not take place, and the powers 
of life are not overwhelmed by the congestion, this latter state becomes wholly 
relieved by an increased action taking place in the capillary system communi- 
cating with the congested veins, and an inflammation becomes established in 
the mucous tissues, and a fever as resulting from it, which, relatively to the 
stage of collapse, is appropriately termed consecutive, but which differs not in 
its nature and results, excepting in intensity, from the common bilious fever of 
this country. 

" 8th. That this inflammatory action succeeding to the simply increased one 
in the mucous tissues of the stomach and bowels, becomes a remedy to the se- 
rous dejections and vomitings, and to the blue or collapsed stage; and is thus a 
remedy, though a morbid one, to the congestion which caused them; while the 
bowels become constipated, the urinary secretion restored, and the alvine dis- 
charges changed from their whey-like appearance, and perfectly fluid state, to 
the colour and consistence of tar. 

" 9th. That the remote cause of the foregoing pathological conditions con- 
sists in a morbid irritation primarily set up in the stomach and bowels by a cer- 
tain malaria, assisted by unwholesome ingesta; — that the malaria is of a specific 
nature, and generated in certain localities conspicuous for defective drainage 
and other definite peculiarities, and modified or wrought into its state of ma- 
lignancy by certain concurrent, but unappreciable conditions of the atmos- 
phere; — that the specific malaria thus modified exerts its influence chiefly in 
the localities where it is generated, and where, from its concentration, it is em- 
bued with the most power; and, lastly, that it affects within the range of its in- 
fluence almost exclusively those only of the community in whom a predisposi- 
tion is induced by the habitual disuse of animal food, and by the derangement 
No. XXV.—Nov. 1833. 19 



210 Bibliographical Notices. 

of the stomach and of the system, and which has resulted from an exclusive, 
and, therefore, inordinate use of a vegetable and ascescent diet." 

The therapeutics of the author is exceeding- simple — 

" The suspended secretion of the liver," he states, "forms the essence of 
the disease; the restoration of its secretion forms the remedy for it; and the 
agent by which this is to be produced, must act upon the stomach, and inter- 
mediately through it upon the liver." p. 75. 

This agent he conceives to be calomel — 

"In giving the remedy it must be borne in mind," he says, " as a principle 
governing its use, that the primary action of the medicine is to be upon the 
stomach, and that its direct action must be limited to it. To effect this purpose 
it is necessary to prevent its early descent into the bowels; and to do this its 
dose should be small, that it may not act purgatively, nor otherwise, as an irri- 
tant, disturb the functions of the stomach, and it should be repeated frequently, 
that its effects be continued, so that all the advantages of a large dose may be 
obtained without suffering the irritation which such a dose would produce when 
given entire. From experience in the effects of a small dose of calomel, as of 
half a grain or a grain, I have long ascertained that for all the practical advan- 
tages of the medicine acting on the liver through the stomach, a small dose is 
at least equal to a large one, with the advantage superadded — and it is no small 
one in cholera — of its producing no irritation. To those who entertain a pre- 
dilection in favour of a large dose of calomel, from the consideration that the 
maximum dose of a useful medicine must be the best one, it may be observed, 
that no rule can be laid down for the appropriate dose of any medicine, when 
directed to a specific object, unless a reference be had to experience as the 
guide to the forming of such rule; for, as to any thing that can, d priori, be de- 
termined to the contrary, a given dose of a medicine may act beneficially, 
while a larger one may have the opposite effect; and thus that one grain of 
calomel, like a moderate quantity of food, may afford a healthy stimulus to the 
stomach; while a large dose often, or twenty grains, which were so generally 
given in this disease, like a repletion from food, may occasion an unhealthy or 
morbid stimulus to it, and either nullify the effect, or substitute a morbid one 
for that which was required. In fact, the maximum dose of a medicine for the 
producing of a given effect upon the stomach, will be always greatly within 
the line in which a given dose of a medicine may be allowed or borne; as it is 
well known that almost every active medicine varies in its effects according to 
the dose which is given of it. Of this a familiar instance is afforded by the drug 
ipecacuanha, whose dose, if minute, and repeated at wide intervals, becomes a 
tonic to the stomach; if somewhat larger, a diaphoretic; still larger, adebilitant, 
by the nausea it produces; and, finally, at its maximum dose, it irritates and 
acts as an emetic. And that which the ipecacuanha produces in its minimum 
dose, as distinguished from that caused by the larger or largest ones of that 
medicine, it is believed that the small dose of the calomel effects with a specific 
power on the liver, through its intermediate and mild agency on the stomach; 
and which is distinct from that which would arise from a large dose, from the 
property this last has to act as an irritant to the stomach, and thence to com- 
municate a morbid irritation to the liver." 

In the premonitory stage Dr. Ayre gave the calomel in doses of one grain 
united with two or three drops of laudanum, and repeated hourly, or every 
half hour, for six or eight successive times, and then every six hours or twice 
a day for a short period, p. 81. In the stage of collapse he administered the 
same medicine in a single grain dose, made into a pill with bread rubbed into a 
mucilage with gum water, and so minute as to weigh, when dry, but one grain 
and a half, taken every five minutes, and with it a single drop of laudanum, or 
Battley's sedative liquor in a tea-spoonful of cold water, p. 82. In a few cases 



Ay re on Cholera. 211 

of extreme severity, he gave two grains of calomel every five minutes for an 
hour or two, and then resumed the ordinary dose of one grain. Dr. Ayre seems 
to depend upon the calomel alone in the treatment of the disease. 

" In the view which I have now given," he remarks, " of the course of 
treatment pursued by me in this disease, it will not fail to be observed, that no 
allusion is made to any other means as auxiliary to the calomel. The truth is, 
that, with the exception of cataplasms of mustard to the stomach, which I some- 
times ordered, and, perhaps, as frequently forgot to order, and bags of hot 
sand to the feet, with a regulated allowance of cold water as drink, I resorted 
to no other means whatever, not even to a single trial of any other, than the calomel 
and opium; for, indeed, my intention was early formed to give an ample trial 
to this treatment; and having a strong conviction that it would be efficient, — 
and which my experience in the treatment early and abundantly confirmed, — 
I determined to unite no auxiliary means with it; since their effect would be 
either to compromise its success, or disturb the conclusions to be deduced from 
it, I considered, in fact, that if the use of emetics, or bleeding, or stimulants, 
or opiates in large doses, or the neutral salts forming the saline treatment, or 
any other of the many means adopted so profusely for its cure on its first en- 
trance into this country, and which were copied, generally, from the practice 
on the Continent, were necessary in any degree, even as auxiliaries to the calo- 
mel in removing the congestion, and restoring the secretion of the liver, that 
my notion of the nature of the malignant cholera must be unfounded, and es- 
pecially in respect to the relation which I assumed it to hold to the common 
cholera of this country, in which, I well knew, no such aids are needed. 

Our readers, we presume, are so satiated with the subject of cholera, that 
they will gladly excuse our not entering into the investigation of the correct- 
ness of the above views. It is almost unnecessary perhaps even to state that we 
are far however, from yielding to them our sanction. It does appear to us that 
it would be just as proper to assert that the suspended secretion of the kidneys 
is the essence of the disease, as that the suspension of that function in the liver 
is, and the argument adduced in support of the latter opinion is equally true of 
the former, viz. that the restoration of the secretion is followed by an ameliora- 
tion in the condition of the patient. But the suppression of both these secre- 
tions is a mere secondary result of the disease, a consequence of the excessive 
secretion from the gastro-intestinal mucous membrane — an exemplification of a 
physiological law, that whenever one secretion is excessive, the others are pro- 
tionally diminished, or entirely suppressed. The indication in cholera, then, 
is to lessen the excessive secretion from the bowels, and we observe that as 
soon as this is effected, if the patient be not utterly exsanguineous, the other se- 
cretions are restored. 

Dr. Ayre treated in private practice 219 patients, of whom 176 recovered, 
or three-fourths, a proportion not greater we believe than attended the treat- 
ment of patients in private practice in this city. Be this as it may, however, we 
suspect that the success of Dr. Ayre's treatment is mainly attributable to the 
cold water and small doses of laudanum, and that the calomel might with great 
advantage have been omitted. We entertain, at the same time, little doubt 
that the treatment we have commented on would be attended with far more 
favourable results than the stimulating and perturbating treatment so general- 
ly adopted in England and elsewhere on the first eruption of the epidemic. To 
those who still feel an interest in the subject, we recommend a perusal of Dr. 
Ayre's work : the author's opinions are fully entitled to a respectful consideration. 



212 



Bibliographical Notices. 



XVII. Fiinfier Bericht uber die verwaltung des Allgemeinen Krankenhauses zu 
Hamburg, betreffend die Jahre 1828, 1829 und 1830. Bekannt gemacht von 
dem Verwaltungs-Collegio, 1832. Hamburg, 4to. pp. 108. 

Fifth Report of the Administration of the General hospital of Hamburg for the 
years 1828, 1829 and 1830. Published by the College of Administration, 1832. 

The report before us presents the statistics of the Hamburg General Hospital 
from January 1828 to December 1830 inclusive. It furnishes in the first place 
a statement of the several items of the income and expenditure of the hospital 
for each of the three years, and a view of its permanent capital with its manner 
of investment. The income of the institution in 1828 was 282,107 marks 
3 shillings and 6 pence, and the expenditures for the year absorbed the whole 
sum with the exception of 624 marks 8 shillings. The income for 1829 was 
293,437 marks 14 shillings 6 pence. The expenditure of the same year fell 
short of this 3400 marks 8 shillings 6 pence. In 1830 the income was 322,103 
marks 1 shilling, of which sum the expenditure fell short 3318 marks 12 shil- 
lings 9 pence. 

Following the account of receipts and expenditures for each year is a general 
statement of the number of patients admitted into and discharged from the 
hospital; which was as follows: — 



Remaining from 


1827 - 


- 


1,235 




Admitted during 


1828 - 


- 


3,693 
Total - 


4,928 


Admitted during 


1829 ~ 


- 


. 


4,342 


do. 


1830 - 


- 


- 


4,605 

Total, 13,875 


Discharged healed 


1828 - 


- 


2,904 




do. 


1829 - 


- 


3,463 


' 


do. 


1830 - 


- 


3,808 
Total - 


10,175 


Discharged relieved 1828 


- 


86 




do. 


1829 - 


- 


93 




do. 


1830 - 


- 


85 

— Total 


264 


Discharged unhealed 1828 


- 


70 




do. 


1829 - 


- 


73 




do. 


1830 - 


. 


49 





Discharged and"^ 
admitted again v» 


1828 


as servants j 




do. 


1829 


do. 


1830 


Died 


1828 


do. 


1829 


do. 


1830 



— Total 



43 



192 



52 
47 

Total - 142 

514 or 10 7-6 per ct. 
597 10 9-15 

643 10 3-4 

Total - 1,754 



Remaining January 1, 1831 



Total, 12,527 
1,348 



Report of the General Hospital of Hamburg. 213 

After some general remarks on the state of the hospital, we are presented 
with the reports of the physician and surgeon, Drs. Sandtmann and Fricke, for 
the years 1828 and 1829. From this it appears that of the 9,270 patients treated 
during- that period, 6,080 were males, and 3,190 females. Of the 6,594 dis- 
charged, 4,591 were males, and 2,193 females; and of the 1,111 who died, 749 
were males, and 362 females. 

In 1828 the fewest patients treated per diem was in July; namely, 1,269; the 
largest number was in December; namely, 1,326. The medium daily propor- 
tion for the whole year was 1,237. In 1829 the fewest number per diem was 
in October; namely, 1,268; the largest in Febuary; namely, 1,374. The medium 
daily proportion for the whole year was 1,335. 

In 1828, 12 male and 4 female patients died immediately on, or soon after 
admission; and in 1829, 14 males and 3 females. Total 33; namely, 1 of rabies, 
1 of fractured skull, 2 of nervous fever, with neglected inflammation of the 
lungs and abdomen, 1 of chronic inflammation of the brain and stomach, 6 of 
apoplexy, 2 of concussion of the brain, 2 of wound of the throat, (suicide,) 1 
of delirium tremens, 1 of inflammation of the brain, 1 of neglected abdominal 
inflammation, 1 of dropsy, 3 of asthma, 1 of gastritis from swallowing sulphuric 
acid, 2 of neglected pneumonia, 1 of fracture of the pelvis, 1 of strangulated 
hernia, 1 of old age, 1 of paralysis of the lungs, 1 of drunkenness, 1 of nervous 
fever, 1 of concussion of the spine, and 1 of apoplexy from enlargement of the 
heart. 

In 1828, 7 males and 1 female, and in 1829, 4 males and 2 females died within 
the first twenty -four hours after admission, total 14; namely, of apoplexy follow- 
ing epilepsy, 1; of paralysis of the lungs, 1; of dropsy from disease of the heart, 
1; of dropsy with chronic pneumonia, 1; of fractured skull, 3; of chronic in- 
flammation of the thorax and abdomen, 1; of strangulated hernia, 2; of delirium 
tremens, 1; of compound fracture, 1; of asthma, 1; of concussion of the brain, 1. 

In 1828, 10 males and 4 females, and in 1829, 5 males and 4 females died on 
the second day after admission, total 23; namely, of haemoptysis, 1; of apoplexy, 
2; of apoplexy after mania, 1; of peritonitis, (male,) 1; of strangulated hernia, 2; 
of compound fracture, 1; of asthma, 5; of nervous fever with asthma, 1; of the 
same with abdominal inflammation, 2; of chronic hepatitis, 1; of the same with 
delirium tremens, 1; of dropsy, 1; of pneumonia, 1; of fractured spine, 1; of 
old age, 1; of hydrothorax, 1. 

In 1828, 8 males and 1 female, and in 1829, 16 males and 3 females died on 
the third day after admission, total 28; namely, of asthma, 5; of nervous fever, 
4; of apoplexy, 3; of the same following delirium tremens, 1; of inflammation 
of the lungs and heart, 1; of strangulated hernia, 1; of fractured skull, 4; of ab- 
dominal tumour, 1; of disease of the heart, 1; of neglected inflammation of 
peritoneum, (male,) 1; of hydrothorax, 1; of nervous fever with gangrene of 
tongue, 1; of abdominal inflammation, 1; of fracture, 1; of nervous fever with 
effusion in the brain, 1; of old age, 1. 

In 1828, 13 males and 7 females, and in 1829, 9 males and 4 females died on 
the fourth day after admission, total 33; namely, of pneumonia, 2; of old age, 
4; of nervous fever, 8; of dropsy, 2; of hydrothorax, 2; of asthma, 4; of strangu- 
lated hernia, 1; of fracture, 1; of abdominal inflammation, 1; of apoplexy, 2; 

19* 



214 Bibliographical Notices. 

of the same following delirium tremens, 1; of pleurisy, 1; of chronic diarrhoea, 
1; of peritonitis, (male,) 1; of fractured skull, 1; of epilepsy, 1. 

In 1828, 6 males and 6 females, and in 1829, 13 males and 2 females died on 
the fifth day after admission, total 27? namely, of nervous fever, 4; of delirium 
tremens, 1; of compound fracture, 4; of asthma, 8; of apoplexy, 2; of nervous 
fever with pleurisy, 1; of chronic hepatitis, 1; of atrophy, (child,) 1; of cancer 
of the stomach, 2? of amentia, 1; of wound of the chest, 1; of dropsy, 1. 

In 1828, 4 males and 4 females, and in 1829, 15 males and 2 females died on 
the sixth day after admission, total 25; namely, of abdominal inflammation, 2; 
of compound fracture, 1; of peritonitis, (male,) 1; of asthma, 5; of pneumonia, 
2; of cerebritis, 1; of nervous fever, 4; of old age, 1; of paralysis of lungs, 1; 
of apoplexy, 3; of dropsy, 1; of scrofula, 1; of palsy, 1,- of fractured skull, 1. 

Making a total of 182 who died within the first six days after admission; 
namely, 135 males, and 47 females. 

The next section of the report is devoted to " particular remarks on certain 
of the patients and diseases treated in the medical wards." This section con- 
tains a brief notice of interesting cases, dissections, and particular modes of 
treatment; presenting a collection of very important and useful facts. This is 
succeeded by tabular monthly reports of the patients treated for mental affec- 
tions. The next section contains a series of interesting and valuable " remarks 
on the cases treated in the surgical wards;" and the report closes with lithogra- 
phic tables, showing the number of patients admitted each month during the 
two years, their diseases and sex, and the termination of each case; — a tabular 
view of the operations performed, with their results, and of the number and 
kind of baths made use of. We have perused with a very great degree of 
pleasure and instruction the entire report, and we could wish that a plan some- 
what similar to that upon which it is drawn up, were adopted for the reports of 
our own medical institutions. D. F. C. 



XVIII. The Cyclopedia of Practical Medicine and Surgery, a Digest of Medica 
Literature. Edited by Isaac Hats, M. D. Part II. Philadelphia, Carey, Lea 
& Blanchard, 1833. 

The second number of the Cyclopedia of Practical Medicine, which has just 
made its appearance, is, we think, calculated to sustain and even to elevate the 
character of that work, and to insure it a sufficient share of patronage. It con- 
tains not less than ninety -five articles. Many of these are necessarily short and 
comparatively unimportant. Nevertheless they could not be excluded without 
greatly impairing the utility of the v/ork, to which the possessor will naturally 
look for an explanation of all the terms he meets with in the course of his pro- 
fessional reading. Several other articles, on the other hand, are of considerable 
length, and written with care and talent, as well as with due regard to the im- 
portance of their respective subjects. 

Among the writers of these latter articles, we find Drs. Harris, Jackson, 
Wood, Bache, Condie, R. Coates, Emerson, Griffith, and Hays, of this city, 
and Professor Geddings of Baltimore. To the first of these gentlemen we owe 
the conclusion of the excellent article Abscess, the commencement of which ap- 



Cyclopedia of Practical Medicine. 215 

peared in the first number. The value of this article leads us to hope that Dr. 
Harris will consent to enrich the succeeding numbers of the Cyclopedia with 
the results of his experience in the department of the healing- art to which he 
has more particularly directed his attention. For the next article of importance 
we are indebted to Dr. Jackson. The subject is Absorption. In this article, 
which occupies ten pages, and contains an abstract of the author's views, and 
not a mere detail of the opinions of other physiologists, Dr. Jackson considers 
the process not as a functional action, but in the light of a vital and organic 
phenomenon, on the ground that absorption is a property attached to every 
particle of organized structure, and not the office of an especial organ or appa- 
ratus. It would not comport with the nature and object of this notice to inquire 
how far this view of the subject is founded; and we will, therefore, content our- 
selves with remarking, that it does not appear to us likely to meet with the as- 
sent of all physiologists, some of whom may object, that as in every portion of 
animal matter, whether membranous or parenchymatous, soft or hard, the pro- 
cess is performed by, or carried on in, certain vessels; and as it has for its effect 
not merely the transmission of all fluids indiscriminately in their original form, 
and with their original characters; but the taking up of only particular fluids, 
and the conversion of all structures into these, it may well be regarded as the 
function of the vessels to which we have alluded. This objection is the 
more entitled to regard, as the action of the minute extremities of those ves- 
sels, and of the ultimate particles of animal tissue where the process com- 
mences, has not as yet been determined in a satisfactory manner, and as the lat- 
ter is only known by its effects, and by its products being found in the vessels 
in question. But however this may be, Dr. Jackson considers the process under 
the following arrangement. 1st. The seat or location of absorption. 2d. The 
mechanism of absorption. 3d. Its physiological, therapeutical, and pathological 
relations. 

In conformity with this arrangement, he examines the process as it manifests 
itself in the skin, mucous membrane, cellular tissue, serous membrane, vascu- 
lar tissue, and lastly, in the interstitial, intimate and parenchymatous structure. 
In reference to the mechanism of absorption, Dr. Jackson, after examining the 
doctrines which refers the process to the lymphatics or to the veins exclusive- 
ly, remarks, that metaphysicians by a mental abstraction have made solidity and 
impenetrability properties of matter. This, however, he considers as a mere 
scholastic subtlety. 

" So far as matter can be brought to our positive knowledge by the senses, 
porosity and penetrability are its constant properties. We have what may be 
regarded as almost the demonstration of the fact in the experiments of Graham 
and Dalton, but more especially in the very ingenious experiments of our intelli- 
gent colloborator, Dr. J. K. Mitchell of this city, exhibiting the penetrativeness 
of gases; and in the experiments of Dutrochet on the endosmose and exosmose 
of fluids through animal and vegetable tissues." •' It may be inferred from 
these experiments, that whatever may be the properties of matter in its ulti- 
mate atoms, of which we know nothing, that bodies, whether inorganic or or- 
ganic, are porous and penetrable by some other substances or matters. This 
property is not a mere passive one, but is active and incessantly in action, al- 
though exercised with different ratios in respect to different bodies. All bodies 



216 Bibliographical Notices. 

are consequently absorptive, actively imbibing-, or respiring in ratios definite 
for each substance." 

The whole article is highly creditable to the author, and will, we are sure, 
be read with great interest by the votaries of physiological science. But while 
saying thus much, we are far from feeling disposed to coincide with Dr. Jack- 
son in his theory of the mechanism of absorption. However important a part 
imbibition may be thought to play in this process, we cannot consent to admit 
that absorption, considered in the whole, is not something different from the 
former. This we would infer from the circumstances that its main products, 
however mixed they may sometimes be with foreign substances, are always 
fundamentally the same, that they are always found in certain order of vessels, 
and that whenever tumours, &c. are absorbed, their products are carried in 
these vessels with the other products we have alluded to. Besides, we are not 
sure that imbibition takes place in the living body, as generally, and to the ex- 
tent that would be required in order to account by means of it alone for the phe- 
nomenon. Were it to do so, we should find lymph circulating in arteries or 
veins, arterial blood in veins and lymphatic and venous blood in arteries and 
lymphatic, instead of each of these fluids being limited to its respective vessels; 
the parenchymatous structure would be drowned in all sorts of fluids, and the 
membranous cavities would always be more or less filled. For what is it that 
could prevent those fluids from being imbibed by the coats or extremities of 
vessels indiscriminately, or by other animal substances? But so far from this 
being the case, lymph is taken up by, and circulates in lymphatics — venous 
blood in the veins; and if extraneous fluids sometimes are imbibed by, and pass 
through parenchyma and membranes, they are soon taken up by vessels whose 
office it is to shield the important organs from the dangerous effects that might 
result from the contact of those fluids with their tissues. 

The next article to which we shall call the attention of our readers is on ab- 
stinence. It is written by the editor, Dr. Hays, and presents a full and interest- 
ing exposition of the state of knowledge on the subject. The author examines 
the extent to which abstinence may be carried — the functional and organic 
changes it produces, the means of remedying its morbid effects, and its advan- 
tages and inconveniences as a remedial measure. On each of these topics much 
valuable information is collected, and the whole is arranged and prepared in a 
creditable manner; though perhaps without a sufficiently strict regard to the 
necessity of conciseness. 

The articles, Jlcacia, Aconite, JLconitum, Acorus, are from the pen of Dr. 
Wood, than whom no one in the whole country could have been more properly 
selected for the confection of the articles on the materia medica. His contri- 
butions to the present number will, we are certain, be considered as among the 
most instructive and interesting in the whole series. An equal degree of praise 
is due to the articles acetates, acetic acid, acetous acid, for which we are indebted 
to Dr. Franklin Bache, whose extensive and accurate knowledge of chemistry 
is universally admitted, and will enable him to do the amplest justice to that de- 
partment of science, the preparation of articles on which it is, we believe, prin- 
cipally his office to prepare. Nor has Dr. Bache furnished, for the present 
number articles on chemistry only. The one on acupuncture is from Ins pen, 



Cyclopedia of Practica I Medicine. 217 

and is entitled to the highest commendation. Indeed this article like those we 
have just mentioned, bears the impress of a master's hand. Acupuncture has 
long occupied the attention of Dr. Bache, who has thereby been able to present 
us with a most satisfactory and instructive account of the nature and effects of 
this therapeutic means. 

Professor Geddings has furnished four articles, Acephalus, Jlcervulus cerebri, 
Adipose tissue, (Anatomy,) Adipose tissue, (Pathology.) The first of these is by 
far the longest in the collection, occupying not less than twenty-eight pages, 
and will command general attention, from its presenting a luminous and truly 
learned account of the subject. The author very properly employs the word 
acephalous in the restricted sense in which it has been used by Chaussier and 
Beclard; confining its application to such monstrous foetuses as come into the 
world entirely destitute of a head. His intention is to include those cases in 
which that portion of the body is partially developed under the terms Anenet- 
phalus, Hemicephalus, Sec. 

" In all the observations which we propose to make relative to acephalous 
monsters, we shall consider, first, those in which the head alone is deficient; 
second, those in which the deficiency involves the upper and lower extremities; 
those in which the upper portion of the vertebral column is absent; fourth, 
those in which the inferior portion of the spine is deficient; fifth, those which 
consist in a defect of a part or the whole of the thorax; sixth, those in which a 
part of the abdomen is deficient; and seventh, those which are accompanied 
with an absence of one or more of the organs. The consideration of the sub- 
ject in this order will lead, in regular succession, to an examination of all the 
topics of importance connected with the configuration and structure of those 
organic deviations, and will enable us to appreciate the reciprocal influence of 
the different organs, to determine their relations, and to ascertain with more 
accuracy the probable modifications of the laws of the living organism which 
are instrumental in inducing such a singular departure from the normal type of 
the individual." 

In accordance with this arrangement, Dr. Geddings passes in review a large 
number of cases scattered in the writings of professional authors, in which 
the head was found deficient. 2. He next cites those in which the neck 
was partially or entirely wanting. 3. Those in which there was a defective de- 
velopment or entire absence of the thorax. 4. Those in which there was an 
imperfect development or total absence of the abdomen. 5. Those in which 
there was an imperfect development or entire absence of one or both arms. In 
a sixth section, he inquires into the state of the abdominal organs in acephalous 
monsters — a, of the organs of digestion; b, of the urinary organs; c, of the ge- 
nerative or sexual organs. In a seventh section he treats of the condition of the 
circulatory apparatus; in the eighth, of the state of the respiratory system; a 
ninth section is devoted to the consideration of the nervous system; finally, in 
the tenth section, Professor Geddings inquires into the vital phenomena of ace- 
phalous monsters. 

As may be perceived, the field which the author has travelled is extensive, 
and the subjects are of the most interesting kind to all physiological readers. It 
remains to be remarked, that the performance is exactly such as could have 
been expected from so distinguished an anatomist and medical writer as Dr. 
Geddings is deservedly admitted to be. The only reproach that might be made 



218 Bibliographical Notices, 

to this article is founded on its great length; but this defect, if defect it be, is 
redeemed by the valuable information — much of which would be difficult of ac- 
cess to most physicians in this country, which it has enabled the author to lay 
before his readers. 

There are several other articles of great merit in the present number, and 
which will no doubt be read with interest. Among these we shall particularly 
cite Acclimatement by Dr. Griffith, Acne by Dr. Emerson, and Acrodynia by Dr. 
Condie. But agreeable as the task would doubtless be to us, we cannot enter 
into any details on the subject of these articles; our object being, not to 
offer an analysis of the work, but rather to call the attention of our readers to 
a few of the leading portions of its contents, and assert its claims to the patron- 
age of the profession. 

On the utility and merits of every literary enterprize, it is natural to expect 
that some difference of opinion will exist; and we can see no reason to hope 
that the present undertaking will meet with a more universal approbation in 
these respects than other works of the same kind. The favourable opinion that 
may be expressed of its contents will therefore be sure to encounter the oppo- 
sition of some other readers. For our part, however, we do not hesitate to ex- 
press the belief, that the number of the latter will be very limited, and that the 
majority of those who examine the work will join us in sentiment, that it 
cannot fail to prove highly useful to physicians at large on this side of the 
Atlantic; and that judging from the preceding and the present numbers, as 
well as from the reputation of the gentlemen whose cooperation has been se- 
cured, it will do honour to the medical profession in this country and compare 
advantageously with the several dictionaries and cyclopedias of the same nature 
and size which have appeared in Europe in the course of the last twenty years. 

L. 



XIX. An Essay on the Yellow Fever. By J. Gillkbest, M. D. Deputy Inspector 
General of Army Hospitals. From the Cyclopedia of Practical Medicine, 
London. 1832. 8vo. pp. 39. 

A treatise on the yellow fever calculated to conduct the reader to a correct 
acquaintance with its nature and treatment, should present a careful analysis 
of those symptoms most constantly present in the different forms of the disease, 
and a very full detail of the post mortem appearances detected by personal ob- 
servation, or recorded by such writers as have had an apportunity of studying 
the disease in the different narts of the world, where it has prevailed most ex- 
tensively. At the same time a careful collection of all the well-attested facts 
connected with the origin of the fever, the climates, localities and seasons in 
which it most constantly appears, and the individuals most liable to its attacks, 
would point out its remote and exciting causes, and more effectually settle the 
question of its contagious or non-contagious character, than the most copious 
citation of the discordant opinions that have been pronounced on this point by 
different writers, and often from the most imperfect data. Had the plan here 
indicated been pursued by Dr. Gillkrest in the essay before us, the reader, 
in place of rising from its perusal, as he now must, with vague and confused 



Gilllsrest on Yellow Fever. 219 

views of many points in relation to the history, nature and treatment of yellow- 
fever, would be placed in possession of all the positive information the profes- 
sion has as yet been enabled to acquire of the causes and pathology of this im- 
portant disease, and the remedies that have been found best adapted to its 
treatment. It is scarcely worth the trouble of any one to collect authorities to 
prove that yellow fever assumes frequently a remittent, as well as a continued 
form, and yet this is a subject upon which Dr. G. places so much importance, 
that he enters upon it at the very commencement almost of his. essay. The 
mere fact of a disease being" continued or remittent is but of secondary impor- 
tance in the study of its pathology. The chief inquiry should invariably be 
into the nature, seat and extent of the local affections by which it is accom- 
panied, for it is from a knowledge of these mainly that our therapeutical indi- 
cations are to be derived. 

We confess that throughout we have been very much disappointed in the 
essay before us; in which we expected to have found a condensed but accurate 
account of yellow fever, and a full exposition of the present state of medical 
knowledge on the various points connected with it. We do not mean to say 
that the essay does not contain much valuable information in relation to the 
history and general characteristics of the yellow fever as an epidemic; but, we 
ask, what definite idea can be formed of the disease from the confused list of 
symptoms which the author presents; or of its real nature from the imperfect, 
or we should rather say incorrect account furnished by him of the morbid ap- 
pearances presented on dissection, and the vague language he employs when 
speaking of its pathology? 

It will scarcely be believed by American physicians, that in an essay on the 
yellow fever, published within the last year, it is denied, most positively, that 
any unquestionable traces of inflammation of the mucous membrane of the sto- 
mach are to be detected after death from that disease. Nevertheless this denial 
is made in this positive manner by Dr. G. Can it be that he is actually ignorant 
of the facts in relation to this subject recorded by Hume, Chisholm, Physick, 
Cathrall, Hunter, Deveze, Currie, Pym, Miller, Ramsay, Jackson, Waring, 
Johnson, and a host of other writers? All of whom bear testimony of the in- 
flamed and even gangrenous condition of the stomach, in subjects who have 
fallen victims to the yellow fever; or is he prepared to deny the correctness of 
these gentlemen's observations, or the honesty with which they are reported? 
Whatever opinion we may form of the nature of yellow fever, its almost in- 
variable connexion with gastric inflammation is a fact placed beyond the possi- 
bility of a doubt. 

Equally unsatisfactory with his account of its pathology are the remarks of 
Dr. G. upon the treatment of yellow fever. Of the most important remedy in 
this disease; the only one in fact, upon which any reliance is to be placed in 
the greater number of cases, namely, bleeding; he states that the weight of 
evidence is against its general adoption, even where prima facie it would seem 
to be indicated. In direct contradiction of this statement, a " weight of evi- 
dence" might readily be adduced, equal at least to that in favour of the employ- 
ment of direct depletion in any other form of fever. Rush, Physick, Griffiths, 
Currie, Miller, Waring, together with the great body of the profession in this 



220 Bibliographical Notices. 

country, have found it to be the most effectual remedy when early resorted to, 
and carried to a sufficient extent; and among- the physicians who have treated 
the disease principally in the West Indies, and the Mediterranean, a similar esti- 
mate of the remedy is made by Jackson, Chisholm, Johnson, Boyd, Musgrave, 
Robertson, Belcher, Burnet, Gibson, and indeed by the major part of all the 
European physicians who have studied the disease with any degree of attention. 
Even while Dr. G. expressed his most decided disapprobation of the remedy, 
he would have dealt more fairly by his readers, had he presented them with the 
important testimony which has been adduced by so many and respectable 
writers in its favour: a remark of a contrary nature may be made in reference 
to the author's account of mercury as a remedy in yellow fever, in this the 
strongest testimonies in favour of its use are adduced, and all the objections 
that have been brought against it are passed over in silence. 

The only part of the essay in which the conclusions of Dr. G. will meet with 
very general approval in this country, is that on the non-contagious character 
of yellow fever. A doctrine which Rush was among- the first to establish on 
correct principles, and the truth of which has been corroborated by all the well- 
authenticated facts subsequently collected in relation to the origin and spread 
of the disease in every country where it has made its appearance. 

D. F. C. 



XX. Wbrkingmen's Library. No. IV. Vol. I. On the Treatment of Infants. By 
a Lady. Boston, 1833. pp. 48. 

Gallantry is among- the few qualities of generous youth, still cherished at ma- 
ture age, which even the critic with his assumed superiority is fain to exer- 
cise, however awkward its observances may be to him when elevated on his 
stilts; and we actually flatter ourselves with retaining- a due share of it, though 
its display may seem incongruous with our elbow-chair dignity. To boast 
of its possession on the present occasion, however, would appear too like the 
blusterings of a coward, inasmuch as there is no demand for its exercise, since 
to speak favourably of the little work under notice is to do mere justice to the 
authoress. It really contains more sound and judicious advice than half the 
bulky tomes on the same subject. The authoress has confined herself to those 
points upon which a lady is competent to instruct, and in relation to which po- 
pular instructions may be safely given; thus showing equal good sense in the 
topics she has selected and in the manner she has discussed them. Her little 
volumes may be commended to the attention of mothers. 



( 221 ) 



QUARTERLY PERISCOPE. 



FOREIGN INTELLIGENCE. 



ANATOMY. 

1. New Membrane in the Eye. — Geouge H. Fielding, Esq. in a communica* 
tion to the British Association for the Advancement of Science, endeavours to 
prove that immediately behind the retina and in connexion with it, there is a 
coloured membrane of a peculiar nature, distinct from the pigmentum nigrum. 
The eyes taken for the purpose of experiment were those of the ox and the 
sheep, in each of which the part in question, of a fine blue or green colour, 
appears at the back of the globe of the eye, immediately in contact with the 
retina, having behind it the true pigmentum. To prove the difference between 
this membrane and the pigmentum, the author quotes Dr. Young's account of 
the latter, in which it is described as composed of mucous and carbonaceous 
matter, as staining white paper, and easily removable from the choroVdes by 
washing it with water and a soft pencil; but according to the author, the mem- 
brane in question will not stain white paper, nor will it part with its colour on 
the application of water. Its surface is bright and polished, and varies in colour 
according to the angle under which it is viewed, and according as it is examined 
by reflected or transmitted light. A portion of it, which was of a pale blue by 
reflected light, appeared of a yellowish red by transmitted light; dipped in di- 
lute sulphuric or muriatic acid, or in solution of ammonia, its colours begin to 
fade; if it is then plunged into cold water, they entirely disappear; if again into 
the acids or alkali, they reappear as bright as ever. The author infers that the 
colours depend not on any peculiar secreted matter, but on the general laws 
for thin plates. 

<■■•■ Examined with a fine achromatic microscope of Chevalier's construction, 
blood-vessels, and even the red globules contained in them, were visible in the 
membrane. By careful dissection in water, it is separable in distinct layers 
from the choroid. Its colour is frequently different in the same species of 
animals; it is usually blue in the ox, the pigment in the same animal being of a 
rich brown; in the cat and fox the membrane is of a golden yellow, the pigment 
a rich black; in the deer the membrane is pale blue, but the pigment a light 
brown. 

The author proposes to name the subject of his researches Membrana versico- 
lor,- he enters into some considerations concerning its probable use in the act of 
vision, suggested by its low reflecting power and immediate connexion with the 
retina; and supposes that vibrations are excited in it by the converging pencils 
of light, and that these are communicated to the contiguous retina, and thus 
transferred to the brain.— Second Report of the British Association for the Ad- 
vancement of Science. 

No. XXV.— Nov. 1833. 20 



222 * QUARTERLY PERISCOPE. 

2. Hermaphrodism. — The following singular variety of hermaphrodism was 
communicated to the Academy of Medicine at their meeting of the 5th of March 
last, by M. Bouii/laud. The subject of it was a person sixty-two years of age; 
by trade a hatter, stating himself to be a widower, and who died of cholera 
in the hospital La Pitic. No suspicion was entertained of the patient not being 
a male until upon opening the body a uterus was discovered. The following 
are the results of a careful dissection made by M. Manec. The penis was of 
ordinary size and well-formed, having a glans and prepuce; the meatus urinarius 
was not exactly in the centre of the glans, but somewhat nearer its lower part; 
the scrotum was rather small, but otherwise quite masculine, being brown and 
puckered; divided by a longitudinal raphe, and shaded with hair; there was 
however no trace of testicles; nothing but such cellular tissue as we find in the 
labia pudendi, or nymphae. The mons veneris was fuller and more prominent 
than in man; the internal organs were two ovaries, two fallopian tubes, and a 
well-formed uterus, of the usual size in the virgin state, and situated between 
the rectum and bladder; it opened by a regular os tincx into a vagina, which 
was of an average size, and two inches in length; where the vagina was close 
to the neck of the urinary bladder, it suddenly contracted, and at the membra- 
nous portion of the urethra it was reduced to a very small tube, which after 
turning upwards opened by an orifice of the diameter of about two millimetres, 
into the membranous portion, so that the urethra was in fact the continuation 
of the vagina. Beyond the opening, the urethra had all the characters of the 
male one; at the neck of the bladder it was surrounded by a prostate; and a 
distinct verumontanum, with the orifices of the prostatic ducts opening at its 
side, was found. The corpus spongiosum urethrae, and the two corpora caver- 
nosa penis were of the usual size and appearance; the acceleratores urinae were 
very large; Cowper's glands also existed. There was no trace of testicles, 
vasa deferentia, or vesiculae seminales; a sort of round ligament passed through 
the inguinal canal. The patient had a thick beard, and the general form of his 
body was intermediate between that of the two sexes. — Journal Hebdomadaire, 
March, 1833. 

3. Anatomical Anomaly. — A recent No. of the Transactions Medicates con- 
tains a notice of an infant which lived fourteen days, and exhibited no signs of 
cyanosis, and in which not only was the foramen ovale largely open, but the 
pulmonary artery, after having given off its branches to the lungs, curved round 
to the left side, and was continueddown alongthe vertebral column in the place 
of the descending aorta which was wanting. The aorta arose as usual from the 
left ventricle, and ascended towards the neck, where it bifurcated. 

4. Bilobed Uterus. — M. Moreau exhibited to the Academy of Medicine at 
the sitting of the 15th of January last, a uterus completely and equally divided 
laterally: the two halves were separated by a double partition. Each half was 
provided with a tube and ovary; and had distinct necks opening into a single 
vagina. The woman died after delivery; the foetus was a male, and had been 
developed in the left cavity. — Rev. Med. Feb. 1833. 

5. Bilobed Urinary Bladder. — At the same meeting M. Velpeau exhibited a 
specimen of a bilobed urinary bladder. The subsidiary pouch was small and si- 
tuated posteriorly, and communicated with the anterior one by an opening near 
the triangular space at the inferior portion of the bladder. A calculus was found 
in the anterior pouch, which could not have been extracted except by the high 
operation, as the incision in the lateral mode must have been made into the 
posterior pouch. — Ibid. 

6. Open Foramen Ovale. — Of thirteen cases of this kind examined by M. Pi- 
geaux, two only of them were accompanied with cyanosis. — Rev. Med. March, 
1833. 



Physiology. 223 



PHYSIOLOGY. 

7. Physiological Effects of various Gases upon the Animal System. — In our 
fourth volume, p. 479, we noticed the experiments of Mr. Broughtox on the 
physiological effects of oxygen gas upon the animal system. Mr. B. has since 
instituted some comparative experiments with various other gases; and the fol- 
lowing are their results, as communicated to the British Association for the Ad- 
vancement of Science at their second meeting. In nitrous oxide, excitement 
followed by debility, bright redness of the interior oi'the body, long-continued 
action of the heart and intestinal canal after sensibility has ceased, and generally 
effects very similar to those produced in oxygen, took place in a much shorter 
space of time. Young rabbits are affected in little more than a minute, spar- 
rows in four or five minutes; cold-blooded animals remain a long time unaf- 
fected, but ultimately die; a kitten left in the gas half an hour was past recovery. 

With regard to other gases, the author states his experience to be at variance 
with a prevailing notion that they are all incapable of entering the lungs, from 
a closing of the epiglottis simultaneously with the,first-drawn inspiration. About 
thirty seconds of time are sufficient to manifest the effects of chlorine when the 
animal falls down insensible. If immediately opened, the heart is found palpi- 
tating, and the peristaltic movements going on. This gas is traced into the 
lungs both by their deep yellow tinge and acquired odour, and the brain like- 
wise smells strongly of it. 

Sulphureted hydrogen destroyed sensibility in about half a minute, and in 
two minutes and a half the heart still palpitated. The lungs and brain exhibited 
a dark brown tint, and smelt strongly of the gas. 

In the other gases, animals do not remain unaffected so long as a minute, 
and contractility is not preserved, as in experiments with oxygen and nitrous 
oxide, although the period of its surviving sensibility and the motion of the 
diaphragm may vary a little. All the gases experimented on probably passed 
into the lungs, with the exception, perhaps, of the carbonic acid gas, immer- 
sion in which is borne without any very sensible effects during nearly three mi- 
nutes, when the animal struggles, and falls down insensible, the blood appear- 
ing very dark-coloured, and the heart still and flaccid. From these results, the 
author extends his deduction of the poisonous character of oxygen in excess to 
the other gases which enter the lungs, and remarks on the specific analogy 
which obtains between the effects of nitrous oxide and fermented liquors. — 
Second Report of the British Association for the Advancement of Science. 

8. On the Effects of Compression and Dilatation upon the Retina. By Sir 
David Brewster. — In repeating many times the well known experiment, par- 
ticularly described by Newton in the sixteenth query at the end of his Optics, 
of the production of light by gentle pressure upon the eye-ball, or a stroke 
upon the eye, Sir David Brewster saw reason to correct the statement of New- 
ton,, that " the colours vanish in a second when the eye and the finger remain 
quiet," having found them to continue as long as the pressure is kept up. With 
respect also to the character of the light thus produced in the eye, the author's 
experience has only shown him black and white circles, with a general red tinge 
arising from the light passing through the closed eye-lids, whereas Newton 
speaks of the colours as like those in the feather of a peacock's tail. 

The author states, — when a gentle pressure is first applied, so as to compress 
slightly the fine pulpy substance of the retina, a circular spot of colourless 
light is produced, though the eye be in total darkness, and have not been ex- 
posed to light for many hours. If light be now admitted to the eye, the com- 
pressed part of the retina is found to be more sensible to the light than any 
other part, and consequently appears more luminous. Hence it follows, that a 
slight compression of the retina increases its sensibility to the light which falls upon 
it, and creates a sensation of light when the eye is in absolute darkness. 



224 QUARTERLY PERISCOPE. 

If we now increase the pressure, the circular spot of light gradually becomes 
darker, and at last black, and is surrounded with a bright ring of light. By 
augmenting the pressure still more, a luminous spot appears in the middle of 
the central dark one, and another luminous spot diametrically opposite, and 
beneath the point of pressure. Considering the eye as an elastic sphere, filled 
with incompressible fluids, it is obvious that a ring of fluids will rise round the 
point depressed by the finger, and that its pressure from within outwards will 
dilate the part of the retina under the finger which was formerly compressed, 
and will compress all that part of the retina in contact with the elevated ring. 
An increase of pressure will be resisted by the opposite part of the retina, and 
will thus produce a compression at both extremities of the axis of pressure, oc- 
casioning the diametrically opposite spot of light, and also the luminous spot in 
the middle of the circular black space. Hence the author concludes, that when 
the retina is dilated under exposure to light, it becomes absolutely blind or insensible 
to all luminous impressions. 

These properties of the retina often exhibit themselves involuntarily, with 
different variations, according to the state of sensibility of the retina, in conse- 
quence of the movement of the eye- ball by its own muscles during the act of 
sneezing, and on other occasions. 

The phenomena above described are those produced in the parts of the re- 
tina which are most affected by any given pressure: but it is obvious that this 
pressure is propagated over the whole retina; and even when it is too weak to 
produce a luminous impression, it may yet modify other impressions previous- 
ly produced on the retina. If, from looking at the sun, the eye sees & pinkish- 
brown spectrum, a pressure upon another part of the retina will change it to a 
green spectrum, which, when the pressure is removed, will again become brown. 
If the pressure is such as to diminish the sensibility of the retina, it will either 
diminish or entirely remove a weak spectral impression. 

When the eye is pressed in front, by putting the finger on the eyelid above 
the cornea, no luminous spectrum is seen, and the author did not venture to in- 
crease this pressure so as to produce an impression on the back of the eye. He 
however mentions a case where this effect was produced accidentally. A per- 
son, in a state of intense grief, had been sitting for some time with his hand 
pressed against his eye;— -the moment his hand was removed, and the eye open- 
ed, a black spot, the size of a sixpence, was seen in the axis of vision. The 
pressure of the blood-vessels upon the retina, in particular states of indisposi- 
tion, occasion floating masses of light, visible in the dark, at first faint blue % 
then green, then yellow, and sometimes even red, all these colours being occa- 
sionally seen at the edge of the luminous mass. 

The preceding observations on the influence of dilatation in making the re- 
tina insensible to light, render it extremely probable that the disease in that 
membrane, called amaurosis, may sometimes arise from a general distention of 
the eyeball, arising from a superabundance of the fluids which it incloses. If 
this be the case, the removal of the pressure might be effected by puncturing' 
the eye-ball, (when this can be done with safety,) and letting out a portion of 
the aqueous humour. How far such an operation would be effectual when the 
disease is of long standing, can be determined only by experiment.- — Ibid. 

9. On the Undulations Excited in the Reiina by the Action of Luminous Points 
and Lines. By Sir David Brewster. — In this communication the author con- 
siders a variety of cases when light affects other parts of the retina than those 
on which it directly falls, — either by rendering them more or less sensible to 
light and particular colours, or by altering the tints which are visible there, or 
by the excitement of undulations in the retina from the illuminated part. The 
following are the results of Sir D. Brewster's experiments on the last of these 
phenomena, as exhibited by the action of luminous points and lines. 

\. If we look through a narrow aperture, about the l-50th of an inch wide, 
at a bright part of the sky, or at the flame of a candle, we shall observe the 



Physiology. 225 

luminous ground covered with a great number of broken parallel lines alter- 
nately light and dark. These lines are always parallel to the narrow slit, and 
of course change their place as the slit is moved round before the eye. Through 
a number of parallel slits, such as between the teeth of a comb, the broken 
parallel lines are seen more distinctly; and if we give the comb a motion oblique 
to the direction of its teeth, the broken lines become more distinct, though 
less straight than before, and new black lines appear, lying in different direc- 
tions, as if they were detached portions of a number of dark ramifications. All 
these phenomena are seen more distinctly when we look at homogeneous light. 
If we use two systems of narrow slits, and cross them at different angles, we 
shall perceive two systems of broken lines crossing each other at the same 
angles; and if when the lines of the two systems are parallel we give one of 
them a rapid alternating motion perpendicular to the direction of its slits, the 
parallel broken fringes are seen with peculiar distinctness. 

2. Phenomena analogous to those now described may be seen by looking at 
a number of parallel black lines drawn upon white paper, such as those which 
represent the sea in an engraved map, or by looking at the luminous intervals 
in a number of parallel wires seen against the sky. If the eye looks at any of 
these objects steadily and continuously, the black lines soon lose their straight- 
ness, and their parallelism, and inclose luminous spaces somewhat like the links 
of a number of broken chains. When this change takes place, the eye which 
sees it experiences a good deal of uneasiness,— an effect which is communicated 
also to the eye which is shut. When this dazzling effect takes place, the lumi- 
nous spaces between the broken lines become coloured, some with yellow and 
others with green and blue light. 

The phenomena produced in these two experiments are obviously owing to 
rectilineal undulations propagated across the retina,- and the interference and 
crossing of the undulations, by which the dark lines are broken into detached 
portions, and by which the colours are produced, arise from the unsteadiness 
of the head or the hand, which causes a want of parallelism in the successive 
undulations. 

3. The action of small and bright points of light upon the retina produces 
phenomena of a very interesting kind. If we look at the sun through a small 
aperture at a great distance from the eye, or if we look at the diminutive image 
of the sun formed by a convex lens or a concave mirror, or seen in a convex 
surface, the light which falls upon the retina does not form a sharp and definite 
image of the luminous point, but it sends out in all directions an infinity of ra- 
diations, covering in some cases almost the whole retina. These radiations are 
extremely bright, and are accompanied in some cases by mottled colours of 
great variety and beauty. The bright point of light propagates around it cir- 
cular undulations, which are broken and coloured by interference, and which, 
being in constant motion from the centre of the retina in all directions, occasion 
the radiations which have been mentioned. 

4. If we look at the radiant image just described through a narrow aperture, 
a very singular effect is produced. A vortex of circular rays appears on each 
side of the radiant point, and the rays have a rapid whirling motion. The line 
joining the centres of the two vortices is always perpendicular to the narrow 
aperture. This remarkable configuration of the rays is evidently produced by 
the union of a system of parallel undulations with a system of circular ones, the 
intersections of the parallel fringes and the diverging radiations forming the 
circular rays, as in the case of ordinary caustics.* 

The preceding phenomena, continues the author, whatever be their true 
cause, clearly prove that light incident upon the retina exerts an action on 
parts of it upon which it does not directly fall, and that the same action renders 
other parts of the retina insensible to the light which actually falls upon these 
parts. 

* Caustic curves, see Brewster's Optics, Am. ed. p . 58, et seq.— Bd» 
20* 



226 QUARTERLY PERISCOPE. 

Upon this principle the author explains the experiments of Mr. G. Smith of 
Fochabers, in which the same object appeared, under certain conditions of 
vision, of different colours to the different eyes, the colour observed by the one 
eye being complementary to that observed by the other. He also refers to the 
same general principle of undulations propagated across the retina, for an ex- 
planation of the remarkable experiment on the eye, first made known by Dr. 
Purkinje of Breslau. 

In this experiment, if a candle be held before one eye, at about a foot dis- 
tance, and in a direction deviating a little from the line of distinct vision, — that 
eye sees a general mass of reddish light around the candle, and in this light, as 
a ground, are seen the ramifying blood-vessels of the retina, the base of the op- 
tic nerve, and the foramen ctntrale. Sir D. Brewster states it to be the most pre- 
valent opinion, that the light which surrounds the candle is reflected back upon 
the retina, either by the inner concave surface of the crystalline lens or of the 
cornea; and that the objects are, somehow or other, magnified by these con- 
cave surfaces. His own view of the subject is, that the light was propagated 
from the luminous image of the candle, and that though the retina, in contact 
with the blood-vessels, is sensible to direct light, it is insensible to propagated 
light, and therefore the blood-vessels must be delineated in obscure lines. As 
there is no retina across the foramen centrale, it will of course appear as a black 
spot; and, owing to the obtuse vision of the optic nerve, it will appear less lu- 
minous than the surrounding retina. 

After the reading of Sir David Brewster's paper, Mr. Wheatstone said, that 
having been the first person to introduce Purkinje's beautiful experiment into 
this country, and having repeated it a great number of times under a variety of 
forms, he would take the opportunity of stating a few particulars respecting it, 
which appeared not to be generally known. — The experiment succeeds best in 
a dark room, when, one eye being excluded from the light, the flame of a can- 
dle is placed by the side of the unshaded eye, but so as not to occupy any of 
the central part of the field of view. So long as the flame of the candle re- 
mains stationary, nothing further occurs than a diminution of the sensibility of 
the retina to light; but after the flame has been moved upwards and downwards, 
through a small space, for a length of time, varying with the susceptibility of 
the individual on whom the experiment is tried, the phenomenon presents itself. 
The blood-vessels of the retina, with all their ramifications, exactly as repre- 
sented in the engravings of Scemmerring, are distinctly seen, apparently pro- 
jected on a plane before the eye-, and greatly magnified. The image continues 
only while the flame is in motion; directly, or soon after, the flame becomes 
stationary, it dissolves into fragments and disappears. 

Mr. Wheatstone dissented from the ingenious explanation of this appearance 
offered by Sir David Brewster, and also from that opinion stated to be the ge- 
nerally received one; and begged to repeat the solution he had published, and 
which he had not since been induced to relinquish. Mr. W. observed, that 
there was no difficulty in accounting for the image; it evidently was a shadow 
resulting from the obstruction of light by the blood-vessels spread over the re- 
tina; the real difficulty was to explain why this shadow is not always visible. 
To account for this, Mr. W. adduced several facts, which tended to prove that 
an object, either more or less luminous than the ground on which it is placed, when 
continuously presented to the same point of the retina, becomes invisible,- and the ra- 
pidity of its disappearance is greater as the difference of luminous intensity between 
the object and the ground is less,- but by continually shifting the place of the image 
of the object on the retina, or by making it act intermittently on the same point, the 
object may be rendered permanently visible. To apply this explanation to the 
phenomena in question, Mr. W. observed, that whenever the flame of the 
candle changes its place, the shadows of the vessels fall on different parts of 
the retina; which is evident from the motion of the figure while the eye remains 
still, which is always in a contrary direction to that of the flame. Hence the 
shadow, being thus made to change its place on the retina, remains, according 



Physiology. 221 

to the law above stated, permanently visible; but instantly the flame is at rest, 
the shadow also becomes stationary, and consequently disappears. 

Mr. Wheatstone then exhibited an instrument for showing" an original varia- 
tion of this experiment: it consisted of a circular plate of metal, about two 
inches in diameter, blackened at its outer side, and perforated at its centre 
with an aperture about as large as an ordinary gun-hole; to the inner face was 
fixed a similar plate of ground glass. On placing the aperture between the 
eye and the flame of a candle, and keeping the plate in motion, so as to displace 
continually the image of the aperture on the retina, the blood-vessels will be 
seen distributed as before, but will now appear brighter, and the spaces be- 
tween the ramifications will be seen filled with innumerable minute vessels, 
anastomosing with each other in every direction, which were invisible in the 
former experiment. In the very centre of the field of vision there is a small 
circular space, in which no traces of these vessels appear. Mr. W. remarked, 
that the absence of these minute obstructions to light will probably account for 
the greater distinctness with which small objects are there seen, and also for 
the difference of colour observed by anatomists in that spot of the retina. — 
Ibid. 

10. Satyriasis Produced by a Blow on the Occipital Region. — M. Chatjffahd, 
of Avignon, relates in the Transactions Medicates for April last, the case of a 
man, fifty-three years of age, of mild character, who, after a fall in his chamber, 
in which he struck violently the lower part of his occipital region against an 
angle of his bed, which produced a swelling, was seized with incessant and 
violent satyriasis and so great salacity that he tried to have connexion with every 
woman that came in his way even with his own daughters. 

11. Case of Paraplegia accompanied with complete Constipation, and the Sup- 
pression of Urine for Fourteen Years. — This extraordinary case was communi- 
cated to the Academy of Medicine at their meeting of the 26th of July last, by 
Sig. Mokte-Santo, of Padua. Several years before the accession of the para- 
lytic symptoms, the patient had sustained a fall from a height upon his back; 
none of the vertebrse were fractured, but the concussion had been so severe, 
that he never recovered entirely from its effects. For fourteen years his appe- 
tite was strong, and he eat his food heartily; after each meal, he drank largely 
of water, and after the lapse of two hours, he felt obliged to take another large 
draught, in order to induce the vomiting of such food as he had swallowed; this 
painful operation recurred every day, from two to five hours after eating. About 
once a month, he had the sensation of, as it were, a ball, which rose from the 
stomach to the mouth; this lasted for four hours or so, and then a large quan- 
tity of feculent matter, mixed with blood, was vomited. On no occasion was 
there the least appearance, not even any smell, of urine in these egesta; the 
renal secretion seemed to be quite suppressed. Since March, 1829, the faecal 
vomitings have never occurred; but each repast is rejected more quickly after 
it has been swallowed than before. The digestion and assimilation of the food 
still, however, go on perfectly well, for the patient has of late become so ple- 
thoric, that he has repeatedly required bleeding. He still lives, and Drs. Graefe 
and Frank have visited the individual, and confirm the accuracy of the above 
statements. 

A similar case was communicated to the Academy, in 1823, by M. Denis. 
There was no evacuation per anum, or excretion of urine, for seventy-two 
years. Probably the kidneys had become atrophied.. 

12. Two Extraordinary Cases of Fasting. — Dr. Schmaiz, of Dresden, in a 
former No. of Hufeland's Journal, has related two very singular examples of 
abstinence from all food, protracted for an almost incredible length of time. We 
must remember, however, that he saw both individuals, and had an opportunity 



228 QUARTERLY PERISCOPE. 

of personally ascertaining the particulars, and moreover the first case was the 
object of a Government inquiry. 

Angelica Vlies was born in the neighbourhood of Delft, in South Holland, on 
20th August, 1787. In her early years her constitution was very feeble and 
delicate, and she was much subject to cramps, induced by intestinal worms, 
which she voided both upwards and downwards in great quantities. She en- 
joyed tolerable health till 1811, about which time she was first seized with vio- 
lent hysterical paroxysms; during these the bowels were obstinately confined. 
Subsequently she had repeated attacks of chronic enteritis, and her appetite, 
which had been throughout very sparing, now began to fail altogether. At 
one time better, and at another time worse, she continued in the above state 
till May, 1818, when she discontinued the use of solid food entirely, and took 
nothing but drinks, chiefly whey. All medicines were rejected by vomiting as 
soon as swallowed. For upwards of four years she tasted nothing solid, with 
the exception occasionally of a little fish and salad, which she sucked, but never 
swallowed. In the Spring of 1822, the attack of hysteria became so violent as 
to threaten death; an enema was given on the 10th of March; the bowels and 
also the bladder were then relieved; and this was the last time that any regular 
evacuation of stool or of urine took place. About this time she refused all 
nourishment whatsoever, fluid as well as solid; and now the catamenia which 
had hitherto been regular, although scanty, ceased. She frequently moistened 
her mouth with a little cold water to abate the burning heat she felt there. In 
July, 1822, an erysipelas appeared on the abdomen; it was relieved by the con- 
stant use of bread and milk poultices. In the following year she had a severe 
attack of dyspnoea, and fixed pain in the left side of the chest. Her physician, 
Dr. Grootenbeer, ordered a blister. In 1824 she had repeated seizures of sub- 
acute arteritis; in 1825 these seizures were neither so frequent nor so severe. 
In October of this year she voided, after most excruciating suffering, a small 
quantity of* urine and faeces; during 1826 she made urine twice, and at each 
time only a few drops. Thus, from the 10th March, 1822, to this period she 
had had relief only once by stool, and three times by urine. The Dutch me- 
dical commission were very anxious at this time to induce her to remove to the 
Hague, in order that an opportunity might be had of strictly inquiring into her 
case; she would not however consent to this; but permitted four nurses to wait 
upon her alternately for the space of a month; the expense of their attendance 
was defrayed by Government. Soon afterwards a memoir was drawn up by Dr. 
Vorstman, and published at Delft, 1827. According to the authentic reports 
of the nurses, Angelica took no food, fluid or solid, from Nov. 11th to Dec. 9th. 
During this time, she used to moisten her mouth with water, tea, or whey; but 
she invariably spat the fluid out again, and the quantity was thus frequently 
somewhat increased, and certainly never diminished; she had no evacuation by 
stool or urine, but had occasionally belchings of wind. During the days, she 
sewed and amused herself with reading. She rose, or rather was lifted from 
bed, at 9 A. M. and was carried back at 11 P. M.; but she slept very little, 
being much distressed with head-ache, swoonings, and cramp. Her age at this 
time was 41, but her appearance indicated more than 60 years, her face being 
shrivelled, and her eyes dull and lustreless; her tongue was clean and dry, the 
skin was parched; the pulse normal in frequency, but exceedingly weak and 
small; the sensibility of the cutaneous, and perhaps also of the deeper nerves, 
was so much impaired, that she was scarcely aware of her skin being pinched 
or pricked. Every hour and a half she was seized with a shivering, followed 
by a convulsive, lateral agitation of the head; these fits lasted generally for 
about two minutes. 

Dr. Schmalz, (the reporter of the case,) visited her in Sept. 1828, and had 
an opportunity of being perfectly satisfied with the truth of the preceding 
statements; she told him that she had not eaten nor drunk any thing since the 
report of the medical commission, nearly two years before; and if we go back, 



Physiology. 229 

we shall find that this extraordinary abstinence had now lasted six years and a 
half, from March, 1822. The patient told Dr. S. that she would very willingly 
take food, if she could in any way swallow it, but that this effort was impracti- 
cable to her. Here the report ceases, and Angelica was still alive at the date 
of the report. 

Casj: II. History of a Female who lived upwards of 2| Years without Food. — 
Professor Ricci, of Turin, has published a full detail of this case in the Reper- 
torio di Medecina, di Chirurgia et di Chimica di Torino. 

Anna Garbero, aged 40, had hitherto enjoyed moderately good health, al- 
though her appetite had been always remarkably sparing; her food consisted 
generally of vegetables enly once a day, and the bowels were not usually re- 
lieved above twice a week. Gradually the appetence became less and less, and 
once she passed 40 days without touching any solid or fluid aliment. But it 
was not till Sept. 1825, that a total inappetite for food came on; it was after a 
very scanty meal, consisting of only a mouthful or two of cabbage and a 
draught of wine and water, that she was seized at once with intense gastralgia, 
which continued for some time, till copious vomiting was induced; from this 
date she was unable to swallow any thing, and even her spittle was thrown 
back when she tried to allow it to pass down. Up to the 7th of the succeeding 
January, she neither eat, drank, nor had any relief by urine or by stool: the 
only appreciable evacuation was that of the catamenia, which, though very 
sparing, returned regularly. 

Dr. Schmalz visited her at this period; he found her so emaciated, that she 
seemed a mere skeleton, over which a dry skin had been forcibly stretched. 
The skin was almost quite insensible to pricking, or to the strongest pressure; 
the limbs were cold and corpse-like; the pulse small and scarcely perceptible, 
but not regular in frequency. The patient was quite willing to make an effort, 
at any time desired, to swallow food, but it was of no avail; and at length the 
mere sight of any victuals, however simple, brought on most painful vomitings* 
Things continued so till the end of June, at which time she became insensible 
and lethargic; this state of apathy continued till the 25th of the following No- 
vember, when she quite suddenly and unexpectedly recovered her senses and 
speech. Her strength became weaker and weaker, and finally was exhausted 
in death on the 19th Ma)', 1828. 

The body was examined in the presence of Professors Rolando and Gallo, by 
whom a very interesting memoir was published at Turin; we give only the 
more interesting and illustrative details. The omentum majus was found drawn 
strongly downwards, and had become adherent to the brim of the pelvis, thus 
leaving the small intestines quite uncovered. This change had been caused by 
the falling down of the transverse colon, which was lying in the pelvic cavity; 
it was distended with hard feces; the small intestines were, on the contrary, con- 
tracted to mere cords. On carefully tracing the colon, it was found that the 
canal of the descending portion was so much obstructed by the swelling of its 
mucous lining, that the faeces could only with difficulty be forced along; the 
obstruction was still greater at the commencement of the rectum, and com- 
pletely prevented the transit of any solid matters. The contents of the ascend- 
ing colon were more fluid, of a dark green, meconium-like colour, and most 
intolerably fetid; two lumbrici and several ascarides were found in the bowels. 

The rationale or etiology of the preceding case appears sufficiently simple. 
We conceive that a chronic inflammation of the colon and rectum had been 
originally caused by exposure to the inclemencies of the weather, for the pa- 
tient was a beggar; thus, not only was the appetite directly impaired, but also 
the passage of the feculent matters obstructed, and the general health became 
more and more deranged in consequence; complete anorexia was the conse- 
quence of the accumulation of the faeces; the colon was dragged down by the 
weight, and, at the same time, the stomach and oesophagus were necessarily 
displayed in a similar direction, and this displacement must have seriously in- 
jured their functions. Besides, traces of a slow inflammation of the mucous 



230 QUARTERLY PERISCOPE. 

coats of the small bowels, and also of the stomach, were found upon dissection 5 
and our readers need not be reminded of the effects which we daily observe to 
flow from such a morbid state. In short, we are to regard the preceding 1 case 
as one of the melancholy results of neglected sub-acute enteritis, originally of 
the rectum and sigmoid flexure, and subsequently of the rest of the canal. — 
Med. Chirurg. Rev. from Hufeland's Journ. der Pract. Heilkunde. 

13. Professor Weber's Experiments on the Sensibility of the Skin. — The Edin- 
burgh Medical and Surgical Journal, for July last, contains an interesting ac- 
count by Dr. Allen Thomson, of these experiments. It is a fact well known 
to physiologists, as Dr. Thomson observes, that there is a considerable difficulty 
in pointing out with certainty, when unaided by sight, any spot on the skin that 
has been touched, and in distinguishing how much of the common feelings of 
touch is due to the sensibility of the skin, and how much is derived from the 
muscular sensation produced by the motion of our limbs. It is also well as- 
certained that some parts of the skin are better adapted than others, either 
from their original structure, or in consequence of their being more exercised, 
to convey to the mind an exact impression of the physical qualities of the bo- 
dies with which they are brought in contact. It must be allowed, however, 
that our knowledge respecting this part of the physiology of the sense of touch 
is by no means definite. 

Professor Weber of Leipzig has lately performed a very simple and ingenious 
set of experiments which illustrate the subject of the sense of touch, and fur- 
nish us with a mode of measuring with considerable accuracy, the relative acute- 
ness of this sense in different parts of the skin of the same or of different indi- 
viduals. 

These experiments consist in placing the two points of a pair of compasses 
at different distances from one another, and in various directions, upon different 
parts of the skin of an individual who is not permitted to see the bodies touch- 
ing him.* Professor Weber thus found, that, according to the distance of the 
two points from one another, we may have the feeling either of one only or of 
two tangent points, and that the distance at which we become sensible of the 
double impression is in the inverse proportion to the acuteness of the sense of 
touch in the skin; or, in other words, that we recognise a double impression 
made on very sensible parts of the skin, although the points are situated very 
near one another, while in those parts of the skin in which the sense of touch 
is obtuse, the points may be removed to a considerable distance from one an- 
other, and yet convey to us the feeling of only one impression. 

Professor Weber has embodied the principal results of his experiments on 
the varieties in the acuteness of the sense of touch of different parts of the skin 
in eight propositions, of which the following is an abstract. 

Prop. 1. The different parts of the skin or organ of touch do not possess an 
equal power of distinguishing two bodies by which they are touched at the 
same time. The distance of the two touching bodies being known, the de- 
gree of this power may be measured; for it is ascertained that if the organ 
of touch does not perceive the contact of two bodies when they are near one 
another, it becomes sensible to the impressions of both when the distance be- 
tween them is increased. 

If the touching points are sufficiently distant, we not only distinguish the im- 
pressions of both, but also the direction, longitudinal or transverse in relation 
to the body, in which they are applied to the skin. When they are brought 
nearer to one another they first give the sensation of the contact of a long body, 
but when brought still closer together they appear as a single point upon the 
skin. 

The ends of the fingers and the tip of the tongue have the power of distin- 

* The sharp points of the common compasses may be blunted with a little sealing-wax, which will 
have the effect also of taking away the cold feeling of the metal. 



Physiology. 231 

guishing the distance of two points nearly equal, and in a much greater degree 
than any other part of the body. At two-fifths of a Paris line we are capable of 
distinguishing the longitudinal from the transverse position of the points on the 
tip of the tongue. At half a line two impressions are felt, more especially when 
the points are made to touch at the same time the upper and lower margins of 
the tongue, or the dorsal and palmar sides of the fingers; but in most other 
parts of the body this is different; for 

Prop. 2. In many parts of our bodies we perceive the distance and situation 
of two points touching us at the same time more distinctly when they are placed 
parallel to the transverse than to the longitudinal direction of the body. 

This may easily be tried in the middle of the arm or forearm: here the two 
points may be distinguished at a distance of two inches when placed in a direc- 
tion across the arm, but they appear as one at this distance, or even, (in some 
persons,) at three inches when placed longitudinally. 

Prop. 3. In those parts of our body in which the impressions of both points 
are clearly distinguished, although not distant, the space between these points 
appears to be greater than in other parts possessing a less sensible touch. 

The experiments illustrative of this are very striking. They may be best 
performed by drawing both the points of the compasses gently along the skin, 
from a sensible to a less sensible part, or vice versa; as from the hand along the 
fingers, from the cheeks or ear across the lips, and towards the nose; from the 
jaw to the chin, from the occiput to the sacrum, with a point on each side of 
the median line, and from the chin to the pubis, in the same manner. In pass- 
ing over the more acutely sensible parts, the points of the compasses seem 
to open or to recede from one another, and the reverse takes place in those 
regions in which the sensibility is obtuse. 

Prop. 4. If the points are placed on two contiguous parts which may be 
moved voluntarily and independently of one another, the double impression is 
much more clearly perceived, and the points appear more remote from one an- 
other, than if at the same distance, they Were brought in contact with one en- 
tire part. This is easily shown on the lips, fingers, and eyelids. 

Prop. 5. We distinguish the two points more clearly, if they are brought into 
contact with two surfaces having a different structure and use, than when they 
are applied to one and the same surface. 

This rule also holds in respect to surfaces possessing different degrees of sen- 
sibility; for in this case also, the points are more clearly distinguished when they 
touch two contiguous surfaces of different powers, than when they are both 
placed on the most sensible of them. This may be seen on the lips, by 
placing one point on the internal, and another on the external surface, in which 
position the points are distinguished at a smaller distance than in any other, al- 
though the surface of the lips directed towards the gums has a much less acute 
sense of touch than the red part. The same is the case with the white and red 
external surface of the lips. 

To the same general rule may be referred another fact, viz. that a smaller 
distance of the poinls is perceptible when they touch at once the palmar and 
the dorsal surfaces of the fingers, than when they are both applied to one of 
these surfaces; and it may also be stated, under this head, that this power of 
distinguishing the points is generally greater when they are applied at equal 
distances on each side of a median line of the body. 

Prop. 6. If we examine attentively the degree of acuteness of the touch in 
each part of the body, we shall find that this varies not only in the larger parts, 
but that there are also small spaces, in some of which the sense is more acute, in 
others in the immediate neighbourhood more obtuse. These points, however, 
do not vary to a great extent in the degree of their acuteness, nor has Professor 
Weber discovered any fixed order according to which they are disposed. 

This observation would seem to show that the nervous fibriles are not quite 
equally distributed throughout the skin. 

Prop. 7. If we are touched with greater force by one of the points than by 



232 QUARTERLY PERISCOPE. 

the other, the impressions of both are distinguished less easily; for the stronger 
obscures the weaker. 

Prop. 8. We distinguish two separate impressions more easily when they are 
not made exactly at the same time? and on this account, in performing all" the 
experiments previously referred to, it is necessary to pay great attent.on in or- 
der to make the contact of both points synchronous. 

The cause of the diversity in the sense of touch in different parts of the body 
is as yet unexplained. It is sufficiently obvious that the greater sensibility 
of some parts of the body does not depend on their being more frequently seen 
than others, as some have supposed to be the case; the middle of the back of 
the hand, constantly exposed to view, is surpassed by the fingers and palm, 
and even by the lower end of the fore-arm; the same is the case with the 
dorsum of the foot. The skin over the os sacrum and coccyx, though be- 
3'ond the range of vision, is comparatively very sensible. The sensibility of 
the sub-mental surpasses that of the sternal and abdominal regions; and, though 
the anterior is generally more sensible than the posterior surface of the body, 
this would appear to be connected with the structure of the skin rather than 
with the sight, for the sacrum and coccyx are more sensible than the pubis. 
Examples of blind persons also, and the great improvement their organs of 
touch are susceptible of from exercise, sufficiently show that sight has very little 
to do with our power of distinguishing by touch different regions of the skin. 
Nor does this power appear to depend chiefly on any mechanical advantage of 
one part over another, as, for example, that some parts are fixed on bones, and 
others very moveable. The tip of the tongue and free part of the lips which 
are loose, and the points of the fingers which are fixed, are possessed of nearly 
equally acute powers of touch. 

The cause of these variations is probably to be sought for in the structure of 
the skin, with which subject we are as yet, as regards the distribution of the 
nerves at least, very imperfectly acquainted. It seems to be obvious, however, 
that the great power of touch does not depend on the presence of papillae, for 
the mammae and some other parts with numerous papillae have yet a very blunt 
sense of touch. The tongue has papillae over its whole upper surface; but it is 
only at the tip that the sense of touch is very acute. 

Many experiments seem to show that the direction of the course of the larger 
and smaller nervous twigs has some influence over the power of the skin, by 
which we distinguish the separate impressions of the points. The greater power 
which we have of distinguishing the points in a transverse than in a longi- 
tudinal position on the arms and legs, while on the face and some parts of 
the trunk of the body a position of the points parallel to the longitudinal 
direction of the body gives the clearest double impression, would seem to show 
that in general the feeling of the distance of the points is most acute, when they 
are applied across the direction of the nerves in their course. There are, how- 
ever, other varieties which cannot be so easily explained in this manner, and it 
becomes necessary to have recourse to the supposition, that the quantity of ner- 
vous matter, as well as the mode of its distribution in the skin, may influence 
to a considerable extent the acuteness of the sense of touch. Sufficient atten- 
tion has not as yet been given to this part of the subject. 

The effect of motion of our organs, and of the bodies touching them, in aug- 
menting the acuteness of the sensation, is very remarkable. When two points, 
for example, placed upon the skin appear as one, we can often recognise their 
double impression by moving the skin. It is thus that by moving the fingers 
we discover the asperities on surfaces which could not be felt, were the finger 
held at rest over them. We also acquire a more accurate knowledge of the 
nature of an impression, by having it made on different parts of the skin in suc- 
cession. By a peculiar internal feeling, called the muscular sensation, inform- 
ing us of the extent of muscular contraction, we come to know the direction 
and space in which our limbs are moved; and every one knows that this feeling 
is of very considerable importance in aiding the sense of touch, and in improv- 



Physiology. 233 

ing that kind of touch frequently distinguished in this country by the term tact. 
It has already been remarked, that it is not unfrequently difficult to discrimi- 
nate whether we judge of the qualities of a surface by the sensibility of the skin, 
or by the muscular sensation. We can in general tell immediately the direction 
in which any one pulls the hair of our head; but the knowledge of this direction 
is not derived, as might be supposed, from the sense of touch, but depends on 
an exertion of the muscles of the head, which is immediately and insensibly 
made with the view of resisting the motion of the head, which without it would 
occur. On fixing the whole head, it will be found that, the power of distinguish- 
ing the direction still remains, though in a less degree. This seems to depend 
on the position of the skin in the neighbourhood being altered by traction, for 
when we fix the skin the power of distinguishing the direction in which the 
hair is pulled entirely disappears. 

Another illustration of this is obtained from the following experiment. Shut 
the eyes, hold the hand steady, and let some one touch your fingers with, and 
carry along their points various substances, as paper, glass, metal, wood, quill, 
leather, linen, silk, or velvet; you will be surprised how often you mistake the 
one for the other, according as they are more or less lightly pressed against the 
fingers. Metals when of the same temperature as the hand can scarcely be 
distinguished from glass and other substances with a smooth surface. When the 
finger of one person is conducted by another into a fluid, the slight pressure 
over a considerable surface informs him of its presence. If a person draws 
a plane surface along the finger of another, pressing at first gently, then gra- 
dually more strongly, and again gently, the feeling of a convex surface will be 
communicated to the finger, and that of a concave surface may be given by the 
greatest pressure being made at each end. 

Professor Weber has also instituted some experiments for the purpose of as- 
certaining how far we are capable of judging of the weight of bodies by 
the sense of touch in the skin, and how far it is necessary that we should be as- 
sisted also by the muscular sensation; for it is obvious that in general we make 
use of both these means to obtain a correct estimate of weight. He found that 
when two equal weights* are placed on corresponding parts of the skin, he 
might add to or subtract from one of them a certain quantity without the per- 
son on whose skin they were laid being sensible of any change or inequality in 
them. He ascertained that when the hand or any other moveable part of the 
body is laid quite inactive on a table, a much greater change can be made in 
the relative weight of the two bodies, without its being perceived, than when 
the limbs are free and capable of muscular exertion: that thirty -two ounces or 
drachms, for example, may be altered by from eight to twelve, when the hand 
is motionless and supported, but only by from one and a half to four, when the 
muscles are in action; and hence Professor Weber infers, that the measure of 
weight by the touch of the skin alone is more than doubled by the assistance of 
the muscular sensation. 

By these experiments it was found that the lips estimate w 7 eight more cor- 
rectly than any other part of the body: the fingers and toes may be reckoned 
next, the second phalanx being inferior to the third, and the first to the second: 
the palm of the hand and sole of the foot, especially the parts covering the ends 
of the metacarpal and metatarsal bones, possess also a considerable power, while 
the back, thorax, abdomen, scapulae, arms, legs and occiput have very little 
power of estimating weight; which observations obviously show a considerable 
correspondence between those parts of the skin possessing the most acute sense 
of touch, and those estimating weights most correctly. 

• The weights employed ought to he made of the same material, and must present the same size and 
form of surface to the skin. In order to insure this, and to correct the difference of temperature, it is 
well to interpose similarly shaped pieces of pasteboard between the weights and the skin. 

No. XXV— Nov. 1833. 21 



234 QUARTERLY PERISCOPE. 



PATHOLOGY. 



14. Fungus Hsematodes of the Bones of the Cranium, Inferior Maxillary Bone, 
and Liver. — A female, whose intellectual powers were but feebly developed, 
and who from her earliest infancy had been subject to epilepsy, paroxysms of 
which disease came on almost every night, but who in other respects usually 
enjoyed tolerable health, became irregular in her menstrual discharge in the 
forty-fourth year of her age. Soon after this period, a small tumour made its 
appearance upon the inferior maxillary bone. After the lapse of a year, when 
Dr. Hanoi first saw the patient, this tumour had acquired the size of a hen's 
egg, was situated upon the right horizontal branch of the Inferior maxillary 
bone; presented a smooth, reddish surface, and was firm, elastic, immoveable, 
and not attended by pain. The tongue at this time occupied its natural position. 
Dreading an operation, the patient refused to submit to any subsequent exami- 
nation until six months had elapsed, at which period the tumour was found to 
have increased to triple its original size, filling the entire cavity of the mouth, 
and pushing the tongue out of its habitual position — it had also become rough 
upon the surface, painful, and evidently divided into two distinct portions. The 
pain continued to increase, deglutition became more and more difficult, and 
she died in a short time from inanition. 

Post mortem. — Upon raising up the integuments of the cranium, a tumour of 
some lines in altitude, about the circumference of a quarter of a dollar, and 
situated upon the right parietal bone, was discovered, it was soft and firmly 
united to the pericardium. At the point corresponding, within the interior of 
the cranium, a similar tumour was observed, which had produced by keeping 
up a continued pressure upon the part, a depression of some lines in depth 
upon the surface of the brain. The dura mater did not adhere to this tumour, 
which was covered in a manner similar to the external one by an adherent mem- 
brane, which being removed, it was found that it was composed of a substance 
resembling the inflammatory coat of the blood. By maceration, this soft sub- 
stance was separated from the bone, which was found covered with spiculae, 
and entirely composed of compact substance, the diploic structure having- dis- 
appeared. At no great distance from this tumour, a portion of the cranium was 
observed of a deeper colour than the neighbouring parts, and apparently de- 
pressed. This was found to be a cavity, situated between the two tables of the 
parietal bone, the exterior one of which was thinner than usual. There was 
likewise observed adhering to the pituitary gland, a small body of a bright 
yellow colour, composed of a substance resembling coagulated albumen. The 
inferior maxillary bone was luxated, and susceptible of motion at its centre. 
The tumour was divided into two portions, each one of which equalled the fist 
in size, they seemed to arise one from the interior surface of the bone, the other 
from its exterior, and were covered by a white, smooth membrane. Their sub- 
stance was white, partly fatty, and partly reduced to the consistence of jelly. 
The bone was completely destroyed at its centre, and splinters of bone were 
found imbedded in the substance of the tumours, which was likewise traversed 
by numerous blood-vessels. The convex surface of the liver presented two 
whitish tumours about the size of a walnut, composed of a whitish, fatty matter, 
and covered hy a thin, white membrane. The other organs were found in a 
normal condition. — Archives Generates, Bee. 1832, from Bust's Magazine, 1832, 
B. 37, S. 1. 

15. Compression of the Medulla Oblongata, by the Odontoid Apophysis of the 
second Cervical Vertebra. Abscesses of the Cervical Vertebrae.— In the month 
of March, 1830, Dr. Hankel was requested to assist in the post mortem exami- 
nation of a little girl, aet. 7, who, for several years had laboured under scrofulous 
tumours and abscesses in the neck, and had likewise suffered from repeated 
discharges of a purulent, foetid matter from the left ear. During the last year 



Pathology. 285 

of her existence, she had been subject to violent head-aches, and pains in the 
left side, particularly in the arm, the latter of which could sometimes be relieved 
by frictions. The left extremities also became atrophied, and appeared to be 
shorter than the right. Her intellectual faculties were by no means impaired, 
and she preserved her memory and senses to the last moment of her existence, 
which was brought about by hectic fever. 

Autopsy. — The extremities of the two sides exhibited a striking- dispropor- 
tion to each other. The glands of the neck were found swollen; the brain and 
plexus choroides were injected, whilst the cerebral substance retained its natu- 
ral tint. Upon the left half of the medulla oblongata, a deep oval depression, 
produced by the processus dentatus of the second vertebra, was discovered. 
This process was moveable, and had passed through the occipital foramen. 
Upon dividing the ligaments of the neck, several ounces of liquid pus, of a 
yellow colour, and mixed with portions of tuberculous matter, escaped. The 
osseous substance of the atlas and second cervical vertebra was friable, and 
corroded by the pus — a more minute examination of the parts was not permitted. 
Tubercles were found in the lungs and mesenteric glands. — Ibid. 

16. Berzelius on the Chemical Constitution of Urine in Various Diseases. — Dur- 
ing the first period of fevers, the cutaneous transpiration being obstructed, the 
urine becomes more aqueous than in its healthy state: when the heat of the 
body increases, with acceleration of pulse, the urine becomes deeper coloured, 
without, however, letting fall a deposit, while its acid reaction diminishes, and 
at last nearly or entirely disappears? it is then rendered turbid by the addition 
of bichloride of mercury, which does not happen when the acid is present. As 
the disease advances the urine becomes more saturated, and is then rendered 
turbid by a solution of alum. When albumen is secreted more copiously, it is 
troubled by nitric acid and heat. When the fever ceases, as, for instance, on 
the seventh day, the free acid suddenly reappears, the colour of the urine 
deepens, and it forms a deposit by cooling. This deposit is not an evacuation 
of morbific matter, but is merely a combination of red colouring matter, with 
uric acid or urate of ammonia, and perhaps nitric acid, in an unknown state of 
combination. In intermittent fever the urine presents these phenomena at each 
paroxysm, and then the deposit assumes a carmine tint. During slow nervous 
fever, there is constantly formed an abundant deposit of uric acid, containing 
little colouring matter; the urine then contains an excess of the phosphates and 
a deficiency of urea, the other ingredients being in their normal proportion. 

In anasarca, which is generally the result of debility of the whole system, 
serum is effused into the urinary passages; hence the urine appears albumi- 
nous, and is troubled by bichloride of mercury, although much free acid may 
be present. After a short time, the kidneys appear to secrete an albuminous 
fluid, which occasions the urine to be precipitated by a solution of alum, nitric 
acid, or heat. As the albumen increases in quantity, the urea diminishes, and 
finally disappears altogether. These phenomena likewise appear in chronic 
hepatitis, dyspepsia, and towards the close of pulmonary affections, especially 
during the last stage of hectic fever. 

During severe vomiting, whether from scirrhus of the stomach or other causes, 
the urine is frequently turbid, and has a milky aspect, letting fall a white de- 
posit, which, when collected, appears mucilaginous, and by desiccation becom- 
ing first yellow and translucent, then white and pulverulent; by affusion of wa- 
ter it resumes its mucilaginous form; pure potass dissolves out of it mucus, 
leaving a residue of phosphate of lime. Hydrochloric acid dissolves the latter 
and renders the mucus transparent, which also dissolves by digestion. This 
state is generally accompanied with alkaline urine, arising from the presence of 
the carbonates of soda and ammonia, diminished quantity of uric acid, and an 
excess of urea. In gout the urine is usually very acid, except during the pa- 
roxysms, when it becomes alkaline or neutral; uric acid is always present in 
considerable excess; the deposit is also abundant by cooling*. 



236 QUARTERLY PERISCOPE. 

In jaundice the urine appears yellow, from an admixture of biliary matter? 
and on the addition of nitric acid, a play of colours is generally produced. Hy- 
drochloric acid renders it green or brown, according- to the state of modifica- 
tion in which the biliary matter exists. Sometimes orange-yellow flocculi are 
deposited: these are soluble in caustic potass, and give the usual reaction with 
nitric acid, in partial hepatic obstructions, when no discoloration of the skin 
has appeared: the bile, by passing through the lymphatic vessels of the en- 
gorged parts, enters the circulation, and may be detected in the urine by eva- 
porating a portion of the latter, digesting the extract in alcohol of specific gra- 
vity .833, and letting the tincture evaporate to dryness. The addition of nitric 
acid will then produce the change of colours — viz. green, blue, violet, and 
yellow — which characterizes the colouring matter of bile. In spasmodic and 
hysteric affections, the urine often becomes limpid and colourless, being, in- 
deed, merely a solution of the urinary salts, deprived of almost every particle 
of organic product. 

In diabetes mellitus, an immense quantity of sugar is secreted. At the first 
access of the disease, the only symptoms are copious emission of urine and di- 
minished appetite; the cutaneous transpiration is obstructed, and the urine is 
supplied with water from all the fluid ingesta. The specific gravity is often as 
high as 1.050; as the sugar increases the urea diminishes, and at last totally dis- 
appears: colour pale-yellow, taste sweet, odour like that of skim-milk; the in- 
organic salts are present in their natural proportion, being merely diluted with 
a larger quantity of fluid. Towards the close of the disease, when hectic fever 
makes its appearance, the urine becomes albuminous, and now passes sponta- 
neously into the alcoholic fermentation; the quantity of urine expelled increases 
to an enormous amount. We may calculate by the following formula the 
weight of the dry extract in solution in the urine, and of course the quantity 
daily expelled. A pint of urine, specific gravity 1.020, leaves by evaporation 
382.4 grains of dry extract; which weight increases in the proportion of 19.2 
grains for each unit of specific gravity, until the latter amounts to 1.050; so that 
if we have a patient voiding urine of specific gravity 1.021, we can determine 
the weight of solid matter present in his urine by making this calculation, 
3§2.4-f-19.2=401.6 grs. in every pint. When diabetic urine is evaporated to 
dryness, and alcohol digested on the residue, the sugar and extractiform matter 
are dissolved; this solution, by repose, leaves either granular crystals, like 
grape sugar, or merely a honey-like mass. We are ignorant whether this dif- 
ference is owing to a diversity of saccharine matter, or to the presence of a 
deliquescent matter, which prevents its crystallizing. Sugar has been sought 
after in vain in the blood of diabetic patients: indeed this disease appears to be 
seated solely in the kidneys, which convert almost every portion of organic 
matter arriving in those viscera into sugar. When a favourable change takes 
place urea reappears, and a quantity of albumen makes its appearance in the urine. 

M. Meisner, who has paid great attention to this subject, gives the following 
quantitative analysis of three specimens of diabetie urine, taken from the same 
patient at different periods: — 



Matter soluble in ether, urea lactic acid, lactate 
lime, extractiform matter 

Matter soluble in alcohol, diabetic sugar, extractive 
matter, and salts 

Matter soluble in water; extractive matter and salts - 

Vesical mucus, subphosphate of lime, and traces of 
peroxide of iron 

Water 



0.34 

7.06 

1.37 

0.34 

91.19 



2. 



0.33 

3.46 

3.44 

0.31 

92.46 



0.65 

5.78 

0.99 

0.46 

92.10 



In diabetes insipidus no sugar is found, but there is present in the urine a 



Pathology. 237 

matter similar to that obtained by digesting alcohol on an aqueous extract of 
muscular fibre: no ultimate analysis of this matter has been as yet made. — Lond. 
Med. Gaz. June 22, 1833. 

17. Pathology of Phlegmasia Dolens. — The following" appearances were ob- 
served on dissection of a woman affected after parturition with phlegmasia do- 
lens which proved fatal. The uterus exhibited nothing remarkable except the 
loaded state of the spermatic veins, which were very large and tortuous; the 
veins of the mesentery were also congested. The vena cava inferior was healthy 
down as far as its juncture with the renal vein, below which it was thickened, 
and filled with a fibrinous substance, varying in its consistence, and adhering 
to the inner coat of the vessel. On laying bare the femoral vein, the subcutane- 
ous cellular tissue was found to be infiltrated with serum, the granules of fat much 
firmer and more distinct than natural, and the intervening cellular membrane 
thickened and opaque. The superficial facia was dense, white, and of a flaky ap- 
pearance, the lymphatic glands in the groin were large, full of serum, and 
closely matted together by condensed cellular tissue. It was extremely diffi- 
cult to detach the iliac, femoral, and saphena veins, in consequence of their 
strong adhesions to their sheaths, and the surrounding organized lymph in 
which they were imbedded. These, together with the popliteal vein, were si- 
milar in condition to the inferior cava, except that the substance they contained 
was thinner, of a brown colour, and somewhat purulent appearance. In the 
remainder of the saphena, and in the veins near the foot, there was a plug of 
coagulum, they were otherwise healthy. The iliac and femoral arteries contain- 
ed a small quantity of blood; the other arteries were empty. 

This case appears to show conclusively that phlegmasia dolens does not de- 
pend solely upon inflammation of either veins or lymphatics, and this is con- 
firmed by a case lately seen by Dr. Graves, in which both saphenas became in- 
flamed and obliterated in consequence of a cutaneous eruption, without phleg- 
masia dolens being produced. — Graves' Clinical Lectures, in Lond. Med. and Surg. 
Journ. April 20th, 1833. 

18. Arteritis and Spontaneous Gangrene of the Right Lower Extremity — Arte- 
ries and Veins plugged up with Coagula. — A girl, aged seventeen, previously in 
good health, was suddenly seized with shiverings, severe pains in the right leg, 
and especially in the foot of that side; the pains were so severe, that the patient 
compared them to tearing the nails from the flesh: in a few days the tempera- 
ture of the limb began to lower and the foot assumed a bluish hue; her suf- 
ferings were not at all abated, in spite of bleeding and repeated leechings, &c. 
She entered La Charite about a fortnight after the first seizure. The constitu- 
tional symptoms were those of general feverishness and malaise; and the pains 
in the foot, leg, and lower part of the thigh were so intense, that the slightest 
motion caused her to scream out; — the skin of the toes and instep presented 
some purplish blotches, and when felt by the hand, the temperature of the 
limb, up nearly as far as the knee, was much lower than that of the other one. 
No pulsations could be perceived in the anterior tibial artery on the instep, nor 
yet in the posterior, tibial, peroneal, and popliteal arteries; they were, how- 
ever, sensible at the upper part of the thigh. Bleeding, general and local, 
emollients, and opiates were prescribed, but without relief; the blood when 
examined was of a blackberry jelly colour, and stained the linen with pale-red 
spots. The purple blotches extended up the limb, and the temperature be- 
came still lower. The constitutional symptoms soon assumed a more formida- 
ble aspect; the breathing was short and anxious; there was intolerable anguish 
and repeated vomitings and hiccup, and no sleep could be procured by any 
sedatives. Cramps and pains were felt also in the left limb, which was swollen 
and tender. On the fourth day after her admission into the hospital, the whole 
right foot was of a uniform brown colour, the epidermis was peeling off, and a 
gangrenous odour arose from it. She died on the following day. 

21* 



238 QUARTERLY PERISCOPE. 

Dissection. — The right foot was of a port wine colour at some points, and at 
others was perfectly black, especially around the toes, where the skin was hard 
and dried like leather; the subcutaneous cellular tissue was infiltrated with 
serum as far up as the lower part of the thigh; the muscles of the foot and leg 
were quite soaked with it, and resembled much the appearance of half de- 
cayed flesh. The left limb was also oedematous. The blood-vessels on the 
right side presented the following appearances; the crural artery from the groin 
to the ham was converted into a hard cord, whitish outwardly, and lined and 
plugged up with a dirty-white friable coagulum, which at some points ad- 
hered to the inner surface of the tube. Similar appearances were found in the 
rami perforantes of the femoral, in the two tibials and in the fibular arteries; the 
internal surface of all these vessels was of a marked livid-red colour; the inner 
coat was not however lacerable, nor very evidently diseased; the vasa vasorum 
were not more developed than natural, and the surrounding cellur tissue was 
healthy. All the veins of the right foot were plugged up with coagula, some 
of a deep black, others of a grayish colour; the lower third of the internal sa- 
phena was also obstructed similarly. On tracing up the external saphena, the 
tibial and fibular veins of the crural, and even along the femoral, and external, 
and common iliacs to their junction with the vena cava, softened coagula was 
found in all, partially filling up their tubes. 

The large nerves of the right limb were much redder than usual, and seem- 
ed as if injected with venous blood. The arteries of the left limb were sound, 
but the veins from the foot up to the common iliac, and even to its junction 
with the vena cava at different parts of their course contained softened broken 
down coagula. 

The medullary substance of the brain presented the curious appearance of 
circular red circumscribed patches at various parts; in each of these circles the 
central point was of a darker hue than the circumference, so that they were 
not unlike to petechia on the skin. The lungs were oedematous; the pulmo- 
nary veins contained fibrous clots, which adhered feebly to the walls of these 
vessels; the right ventricle of the heart was occupied by one large coagulum, 
which had all the appearance of gooseberry jelly. Numerous small petechial 
spots existed on the pleurae, costalis et pulmonalis. 

Remarks. — We have observed that the lining surface of the arteries of the 
right limb was found reddened, but that there was no other sign or mark of 
morbid change in it. It has been much disputed by pathologists whether we 
are to admit this appearance as a test of preceding arteritis: Haller, Meckel, 
Bouillaud, Broussais, and others contend that it is; whereas, Corvisart, Laennec 
and Hodgson, Andral, Sec. are of a different opinion, and assert that it is a 
" cadaveric phenomenon." 

The following valuable observations are taken from the article " Arteritis," 
in the Dictionnaire de Medecine, et de Chirurgie pratique. "The redness 
may be wanting in true inflammation of the arterial tubes; and on the other 
hand it may be often observed, where no inflammation had ever existed; we 
not unfrequently see it in examining bodies which are partially putrid; and in 
these the imbibition of the bloody serum is no doubt the cause of the redness. 
Thus, we are not to consider the redness and swelling as pathognomonic mor- 
bid phenomena; nor yet, should they be wholly discarded. It must be admit- 
ted, however, that in by far the greater number of cases of arteritis, the red- 
ness, if it does exist, is not caused by the injection of the vasa vasorum, but 
rather by a tincture, or as it were a fixing of the colouring matter of the blood 
on the internal surface of the vessels; and that therefore this inflammatory blush 
does not essentially differ from the cadaveric imbibition." 

Cruveilhier is of the same opinion as Bouillaud, the author of the article in 
question; he does not consider the mere presence of a red colouring of the 
inner coats of the arteries as characteristic of inflammation; we should find at 
the same time a pencilled injection of the vasa vasorum in the cellular coat of 
the vessels, and also coagula adhering more or less firmly to their inner surface; 






Pathology. 239 

it is this last appearance which, according 1 to Cruveilhier, is to be depended 
upon chiefly. Gendrin, Delpecb, and Dubreuil, state, that in arteritis, the lin- 
ing surface of the vessels is red, has lost its glistening smoothness and polish, 
is somewhat rough or wrinkled, and may be readily detached, and that the 
other tunics are swelled and softened. The subject is still open to difference 
of opinion. Cruveilhier, as stated above, considers that the essential or pathogno- 
monic character of inflamed arteries is, that the blood within them is coagulated. 

But we must be on our guard, lest we are led to believe that this change in 
the blood is found in all inflamed arteries; this is certainly not the case, as is 
fully established by M. Barde, in the first vol. of the Revue Medicale, and by 
M. Bouillaud, in his treatise on fevers. On the contrary, Haller expressly 
states — "In vasis etiam vivi corporis sanguis coit," and the truth of the remark 
is confirmed by every one. 

M. Alibert, in his inaugural thesis, gives it as his opinion, that in cases of 
gangrene with arteritis, the formation of the clots precedes, and actually occa- 
sions by their irritation, the inflammatory state of the lining membrane of the 
arteries. Several very interesting examples are detailed in this thesis; in the 
2d and 3d cases softening of the brain was found, with the morbid changes in 
the veins of the mortified extremity; and in the latter of these two cases an ad- 
herent clot was found in the left auricle; in another case, a clot was found in 
the pulmonary artery, and in a subsequent one, these sanguineous concretions 
existed not only in the vessels of the sphacelated limb, but also in the aorta, 
and in all its branches given off below the diaphragm; and in the common, in- 
ternal, and external iliacs. Besides the venous trunk on the surface of the 
brain, and of the dura mater contained coagula; and at the upper and back part 
of the right hemisphere, a large black spot, two inches at least across, was ob- 
served; the texture of the brain was here exceedingly softened, and quite of a 
creamy consistence. — Med. Chirurg. Rev. from Archives Generates. 

19. Remarks on the Value of Pathological Anatomy. By James Johnson, M. D. 
— In the earlier days of physic, when morbid anatomy was uncultivated, and 
when, consequently, medicine had not the degree of exactness which it now 
possesses, men were thrown solely on the observation of facts, and a vast body 
of empiric experience was accumulated. We say empiric, because the nature 
of disease was unknown, and the observation consisted only in the statement of 
the results of the application of certain remedies to certain symptoms. Much 
practical truth was, no doubt, obtained; but, as many symptoms constitute only 
the common language of certain stages of diseases, totally differing in their 
characters and seat, it followed that much of the experience was fallacious, and 
men were ignorant why a drug succeeded in one case and utterly failed in an- 
other, which, to their eyes, appeared of a similar description. Hence all the 
vagueness, and much of the opprobrium, of physic. 

When morbid anatomy was first explored, and its vast mines of real and so- 
lid infoi'mation opened, men were dazzled by the glare of the wealth around 
them, and thought that it would suffice for all their necessities and wishes; in 
other words, they imagined that, to become good practitioners, it was merely 
necessary to know the real nature of disease, and the structural changes that 
accompany and occasion symptoms. The example of France is alone sufficient 
to display the fallacy of this expectation. 

The truth is, that both means are necessary to constitute the knowledge 
available in practice. We should know the seat and the structural nature of 
disease, or we sink into empirics, and exactness is lost; we should know the 
effects of remedies on symptoms, as well as on structural lesions, or we become 
mere barometers of vital changes diagnosticating, prognosticating, doing every 
thing but cure. 

At the present day, these two roads to knowledge may, happily, be joined. 
Men conversant in the exact truths of morbid anatomy may set themselves to 
observe the effects of medicines, and we need not say how incomparably supe- 



240 QUARTERLY PERISCOPE. 

rior the record of their experience is, to that empiric jumble of facts and fan- 
cies that has descended to us from our forefathers. We now appreciate the ef- 
fects of remedies with some measure of certainty — we see how far organic le- 
sions are amenable to treatment, and what medicines or means relieve particu- 
lar symptoms, or sets of symptoms, not dependent on such lesions. In short, 
we have now a rational and scientific series of experiments, in clinical observa- 
tion. — Med. Ckirurg. Rev. July, 1833. 

20. On Hydatids and their Conversion into Tubercles. — M. Ktthx has lately 
read before the French Academy a memoir on acephalocysts, and the manner 
in which these parasitical productions give rise to tubercles. He holds the opi- 
nion of Laennec, Bremser, and others, that they are to be considered as truly 
of an animal nature; and draws a distinction between those found in the human 
body, from what are often seen in sheep and other lower animals; the former, 
says he, are always propagated by internal buds, or growths which are thrown 
off from the inner surface of the original hydatid, and may be, therefore, deno- 
minated "endogenous;" they may be compared to a nest of boxes, one within 
the other, whereas the latter produce buds only on their outer surface, and 
are, therefore, " exogenous." It was after a very careful examination of the 
lungs of oxen, which had died of a species of phthisis called " pommeliere," 
that M. Kuhn was led to the belief of the degeneration or conversion of hyda- 
tids into tubercles. The hydatids, by their irritation, cause cysts to be formed 
around them; these cysts become stronger, fibrous, or even cartilaginous; mean- 
while, the acephalocysts enlarge by serous imbibition, and multiply by buds 
from their inner surface; these again, in course of time, give rise to others, the 
whole nest being contained in one bag. From the inside of this bag is secreted 
a yellowish viscid matter, which becomes thicker and thicker; M. Kuhn re- 
gards it as the primitive tuberculous deposit: it gradually solidifies, and, with a 
simultaneous shrinking of the cyst, tends to squeeze and kill the enclosed ani- 
mals, thus giving rise to a nucleus of tubercles. Sometimes the tubercles are 
not entirely filled up, but are hollow, and we observe only the shell or dried 
husk of the acephalocyst; we may even separate the thin layer of the animal 
from the debris within, by immersing some of the tubercles in water. M. Kuhn 
has enriched his memoir with beautiful illustrative drawings; they throw much 
light on the etiology of the tubercles which are found in the lungs and liver of 
ruminating animals. The coexistence of hydatids and tubercles, in the same 
organs, is a fact at once curious and most interesting. The subject is one of 
much importance, and deserves future examination. — Ibid, from Revue M6di- 
cak. 

21. Sudden Death from Paralysis of the Lungs. — The German authors attri- 
bute to this cause many of those instances of rapidly-fatal dyspnoea, which not 
unfrequently occurs during the course of other diseases, especially of phthisis. 
It is not uncommon for a medical man to leave his patient moderately comfort- 
able, and apparently free from any immediate danger; and yet, in the course of 
a very few hours after, to be summoned to witness his death from complete 
strangulation. Dr. Shaeffer, of Ratisbon, first employed the appellation of pul- 
monary palsy to denote this affection; Storck called it catarrhus suffocativus, 
and Kerksig asthma paralyticus. It is common among infants, but still more so 
with old people. M. Lobstein regards many of the cases reported by Andral, 
(who was at a loss how to explain their fatality,) as instances of this disease. 
The following is an example. 

A young man, aged twenty-eight, was admitted into the Strasburg Hospital 
with symptoms of general fever. Bleeding was ordered, and performed at 9 
o'clock in the morning. At this time, there was no marked distress in the 
breathing; two hours afterwards intense dyspnoea came on, and this was ac- 
companied with a strong mucous rale; the dyspnoea was speedily aggravated to 
orthopnoea; a severe pain and inward heat were felt along the entire length of 



Materia Medica. 241 

the spine. The bleeding was repeated, with some relief to the symptoms, but 
the patient died soon after quite asphyxiated. On dissection no satisfactory 
morbid appearances were found. 

Two other similar cases are reported; they occurred in phthisical patients. 
M. Louis, in his great work, " Recherches Anatomico-pathologiques sur la 
Phthisie," inquires — " how shall we explain so sudden a death, when there 
has been no apparent accident, nor any precursory nor concomitant phenome- 
non?" We answer that it is not necessary to discover indurations, hepatiza. 
tion, engouement, or ulcerations, upon dissection, but that we must remember 
that the lungs are vital organs, and that their vitality may become suddenly af- 
fected by paralysis. — Ibid, from Archives Generates. 



MATERIA MEDICA. 

22. Therapeutic effects of the Syrup and Extract of the Shoots of Asparagus. — 
The following observations by M. Gendrist, relative to the action of the syrup 
of the shoots of asparagus, are calculated to fix the value of that therapeutic 
agent. The syrup employed by M. Gendrin had been made the preceding year, 
and he administered it to persons in health and to those who were slightly un- 
well. He daily observed the state of the pulse in these persons, and mea- 
sured the quantity of their drinks, and the urine they passed. All of them 
without exception had the quantity of their urine increased, and this commenced 
when the syrup was given in the dose of an ounce to an ounce and a half, but 
was not very marked until two ounces of the medicine were taken at a dose. 
When taken in this dose the urine tripled, quadrupled, and even quintupled the 
quantity of drink, in all the individuals. When this abundant diuresis was es- 
tablished, the greater number of these persons experienced thirst, and all had 
a considerable increase of appetite. M. G. repeated these experiments upon 
three series of persons, consisting of three, of five, and of four. He never gave 
with the medicine any other drinks or other medicine than a pint and a half of 
barley water, and of liquorice-root water. He never found the least odour of 
asparagus in the urine of these persons, nor their pulse to be lessened a single 
stroke. The day after the syrup of the shoots of asparagus was suspended, the 
diuresis ceased. In this respect the diuretic differs from the digitalis, after the 
use of which the patients continue to urinate copiously for seven or eight days. 
M. G. has administered the syrup of the shoots of asparagus to patients affected 
with dropsy, and particularly where that disease resulted from an affection of 
the heart. In all diuresis was produced; the remedy never failed except in 
patients in the last stage of the disease, when it is known that all diuretics fail. 
The action of the remedy upon patients affected with disease of the heart was 
never observed by any effect upon the heart. " If, 5 * says M. G. "some of them 
have had their dyspnoea relieved, this is what results in these cases from the use 
of all diuretics, when the diuresis is well established; this however does not 
prevent my admitting that there are some diuretics which act upon the heart. 
But I affirm that I have never been able to discover after the most careful exa- 
mination, either in healthy persons or in those affected with disease of the 
heart, the slightest influence exercised over the action of this organ by the sy- 
rup of the shoots of asparagus." 

M. Gendrin has also used the extract of the shoots of asparagus, prepared by 
evaporating their juice. The extract he used corresponded to 48 grs. for an 
ounce of the syrup. This he states to be more actively diuretic than the syrup. 
In the dose of 36 grs. it acts very powerfully, and in the dose of 48 grs. it is as 
efficacious as the syrup in the dose of two ounces. It does not exert any ap- 
preciable action upon the heart; does not produce any effect on the digestive 
organs, nor give any odour to the urine— Gas;. Med. de Paris, June, 1833. 



242 QUARTERLY PERISCOPE. 

23. New Preparation of the Caustic Potash for Cauterizing. — The following 
preparation in use at Vienna, is lauded in a communication by Dr. Hen^au, of 
Odessa, in the Rev. Med. for February last, as an exceedingly convenient means 
of cauterizing, and as having the advantage of making an eschar of such pre- 
cise form and size as the surgeon ma)' desire. Take of powdered quicklime six 
parts; caustic potass, five parts; pulverize the potass in an iron mortar, adding 
gradually the powdered lime. A fine, very dry, grayish-white powder is thus 
obtained, which is to be preserved in a closely-stopped glass bottle. When 
wanted for use, a sufficient quantity is to be poured into a saucer, and enough 
spirit of wine or Cologne water added to make a paste, which is to be mixed 
up and made into the shape and size of the desired eschar. This is to be ap- 
plied to the part, and in about five or six minutes the skin will be cauterized to 
the cellular tissue, which may be known by the appearance of a small gray line 
on the borders of the caustic paste. This last may be then removed, and the 
eschar washed with a little vinegar. If it is desired to cauterize more deeply, 
the paste is to be allowed to remain on ten, fifteen, or even twenty minutes. The 
pain it produces is said to be moderate; less than from a blister. 



PRACTICE OF MEDICINE. 

24. Anodyne Metallic or Galvanic Brush. — Under this name Francis Ernest 
Vox Hilbeivbra^b, professor of pathology and practice of physic at Pavia, des- 
cribes a rather singular remedy, for the cure of various neuralgic affections. It 
consists simply of a bundle of metallic wires, ffascis efilis metallicis confectum,J 
not thicker than common knitting wires, firmly tied together by wire of the 
same material, so as to form a cylinder of about four or five inches long, and 
one inch or three-fourths of an inch in diameter. This is applied to the pained 
part, previously moistened with a solution of sea-salt, when it produces relief so 
instantaneous, it is said, that it appears to the patients like the effect of a charm. 
Occasionally the pain is immediately and entirely extinguished, with the accompa- 
nying effect of a peculiar sense of emanation from the spot to which the brush is 
applied, causing the patient to believe that the pain is truly extracted by this 
method. On withdrawing the brush, the uneasiness occasionally returns, but 
in a more endurable form. The longer the application is continued, the more 
decided is the effect obtained; and phenomena so singular have resulted from 
its application, as even to astonish intelligent persons, quite on their guard 
against any magical illusion. 

In illustration of the remedial effects of this agent, Hildenbrand mentions the 
following case, which he designates as altogether singular and wonderful. A 
man of thirty, a porter by occupation, afflicted with violent periodical tic 
doloureux of the face, (~metopodynia,J was admitted into the Clinical Wards of 
Pavia. On applying the metallic brush over the left frontal nerve, the pain im- 
mediately disappeared from that one, but fixed on the corresponding nerve of 
the right side, which had been previously free from pain. The very moment 
at which the brush was removed from the left frontal nerve, the pain returned 
to its original seat, and there remained, though already remarkably abated in 
intensity. By applying a metallic brush to each supra-orbital nerve simultane- 
ously, the professor banished the original nerve-ache of the left side, and at the 
same time prevented it from appearing in the opposite one. The same moment, 
however, a humming noise arose in each ear, and this also immediately ceased 
on the brushes being removed, when the nerve-ache returned immediately, 
though in a very mitigated form. < 

In order to obtain the desired effect from the use of the anodyne brushes, 
Professor Von Hildenbrand impresses the necessity of determining, as accurate- 
ly as possible, the nature of the neuralgia, or the pathological state of the af- 
fected nerve. If the pain is merely nervous, that is, proceeding from subversion 



Practice of Medicine. 243 

of the equilibrium between the dynamic factors of the sensitive life, as the Pro- 
fessor, in imitation of his father, expresses it, without material changes having 
taken place in the affected part, in which case it attacks periodically, like an 
intermittent disease, and leaves intermissions entirely void of pain, — then the 
efficacy of the metallic brush may be pronounced to be almost infallible. But 
if, from the pain being 1 uninterrupted, or at least void of perfect intermissions, 
from its aggravation underpressure of the part, from the conjunction of redness, 
heat and swelling, there is reason to believe that the proximate cause of any 
case of facial neuralgia or hemicrania, consists in a state of active congestion or 
sub-inflammatory irritation, — then the metallic brush affords no benefit, nay, 
sometimes may augment the intensity of the pain. By these means, Professor 
Hildenbrand thinks that the metallic brush, while it maintains at least a pallia- 
tive therapeutic property in neuralgia of spasmodic character, may, in doubtful 
cases, furnish an auxiliary diagnostic sign, by the aid of which sub-inflammatory 
congestion may be distinguished from simple nervous erethism. 

In the first experiments, performed by Professor Hildenbrand, he employs 
brushes which were intentionally constructed of two kinds of metal, for instance, 
silver and copper wire, copper wire and zinc wire, or zinc wire and brass wire, 
the individual wires being mutually mingled and blended, on the supposition, 
that electricity or galvanism, evolved by the contact of heterogeneous metals, 
might be the beneficial and sanative agent. He afterwards ascertained, how- 
ever, that bundles of wires of one and the same metal produced an effect 
scarcely less speedy, but lost their anodyne influence as soon as they were 
covered by rust or verdigris. He further ascertained, that solid metallic bodies 
produce analogous effects, but in a much feebler degree than the numerous 
acuminated points of the bundle consisting- of metallic wires. The nature of 
the metal, he adds, seems to cause no difference; for brushes of iron wire pro- 
duce the anticipated alleviation in as great a, degree as those of copper wire. If 
he could trust his observations, however, he thinks that he perceived a greater 
degree of anodyne virtue in copper, iron, and gold, than in other metals. 

Admitting that the effect is constant, — to explain the theory of its produc- 
tion, Professor Hildenbrand does not hesitate to deduce it from the laws of 
electricity. The original nature of metallic bodies, which are remarkably good 
conductors of electricity; the rapid action of the brush if the aching spot has 
been previously moistened by the saline solution; the remarkable tendency of 
pointed bodies in attracting electricity; and the sense of an emanation, and an 
agreeable coolness, combined with manifest alleviation of pain admitted by the 
patients, he regards as no trifling arguments to infer, in the disordered and 
aching nerves, a certain degree of electric plethora, or accumulation of animal 
electricity, which may be discharged by the application of a suitable conductor. 
This hypothesis, he lastly remarks, would accurately correspond with the 
notions delivered in his elements on the accumulation of the imponderable 
Biotic principle in various parts of the nervous system, as the proximate cause 
of nervous disorders which attack in paroxysms, and are dissipated by what he 
denominates autocratic explosions. 

We have given the foregoing statements without comment or remark, be- 
cause they proceed from a physician of acknowledged judgment and observa- 
tion. Taken by themselves, the facts, if facts they are, are extraordinary, and 
would lead us to believe that there was something more than fancy and mum- 
mery in the magnetic tractors of Mesmur. On a former occasion we adverted 
to the implicit confidence which Laennec reposed in the use of electric or 
electro-magnetic plates on the breast and back in angina pectoris, and similar 
neuralgic affections of the chest; and were disposed not only to doubt its alleged 
efficacy, but to regard it as mere influence of imagination. Both methods of 
treatment appear to be referable to the same principle, whatever that may be; 
and as both appear to be regarded as really efficacious by physicians, certainly 
not of second rate importance, we think that instead of being- made the subject 
of ridicule, which is too often the case, and which can neither decide the matter 



244 QUARTERLY PERISCOPE. 

of fact, or investigate the principle, they should be subjected to fair trial, and 
their actual merits truly determined. 

In order to understand the theoretical views of Professor Hildenbrand, it is 
necessary to observe, that his father, Valentine Ernest Von Hildenbrand, whose 
doctrines he adopts, imagined that health consists in a process which he names 
organic-dynamic, as depending- on the soundness of organs, and the harmony of 
function, — resulting from the perfect equilibrium of the gangliar system and 
the vascular system, which he termed the two factors, in imitation of the lan- 
guage of mathematicians; and that every form of disease consists in the greater 
or less subversion of this equipoise of the gangliar and vascular systems. The 
Biotic principle is simply the result of this equilibrium. — Edin. Med. and Surg. 
Journ. April s 1833. 

25. Asphyxia of New-born Child V en. —Dr. Patterson recommends cold affu- 
sion in these cases, and he cites in the 8th No. of the Dublin Journ. of Med. and 
Chem. Sc. two cases in which he has employed it successfully. 

26. Cases of Pleuropneumonia treated by Large Bleedings. — The following 
cases were treated by M. Bouillaud, one of the ablest disciples of the physio- 
logical school; and will show with what justice the practice of that school is 
stigmatised as feeble and unsuited to violent diseases. 

Case I. Pleuro-pneumonia of the right side, in the second, stage — great prostra- 
tion. — F. G. aged fifty-eight. "When he was brought to the Hopital de la Cha- 
rite, so great was his exhaustion that he might have been supposed to be af- 
fected with malignant typhus, had not the sputa, which are so characteristic of 
acute inflammation of the lungs, and the signs obtained by exploring the chest, 
removed all uncertainty from our minds. The sputa were viscid, transparent, 
and of a rusty colour. Percussion over the fossa supra-spinata gave out a dull 
sound; and at that part no respiratory murmur could be heard; but along the 
base of the scapula and between its inferior angle and the spine, a bronchial, 
or blowing respiration, and a strong resonance of the voice, amounting almost 
to cegophony, were perceptible. Lower down, a crepitant rale of small bub- 
bles was heard, and the sound was somewhat obscure. He had been bled the 
day before, and the blood was sizy. Ordered to be bled freely, and have twelve 
leeches to the chest. Next day, (22d) the blood was found to be buffy and 
cupped; the patient felt relieved; auscultatory symptoms the same; pulse 110; 
respirations from 32 to 36. To be again largely bled, and the chest, when it is 
painful, to be cupped. On the 24th all the symptoms were much abated; and 
in spite of the active depletions, the patient felt stronger; the same dullness on 
percussion remaining; the resonance of the voice no longer accompanied with 
the oegophonic shrillness; bronchial respiration as before; crepitant rale heard 
very distinctly over the fossa infra-spinata, and under the inferior angle of the 
scapula; pulse 92; respirations 28. On the 26th percussion yielded a sound less 
dull; bronchial respiration and bronchophony remaining. The patient was 
now convalescent; but, althongh the returning crepitating rale, "rhonchus 
crepitans redux," extended itself considerably, the dull sound on percussion, 
and the bronchial breathing continued; in a few days he left the hospital well. 

Case II. Pleuro-pneumonia of the left side, in the second stage. — P. L., aged 
thirty, entered the Hopital de la Chante on the 21st of September. She had 
pyrexia, pain in the chest, cough, dyspnoea, and expectoration of transparent, 
glairy, and rust-coloured sputa. She was largely bled; and on the following 
day the report is, that the symptoms are still very urgent; breathing very hur- 
ried and laborious, 48 to 52 times in the minute, and at each act of inspiration 
the alae nasi are violently lifted up; the cough is painful and frequent; the sputa 
rusty, gummy, and flowing out when the vessel is inclined, " en nappe." On 
percussion, the chest sounds well in front, but behind, on the left side, there 
is dullness over the whole of the fossa infra-spinata, and then no respiratory 
murmur is to be heard, but a bronchial blowing, or " souffle," and a jerking 



Practice of Medicine. 245 

resonance of the voice. The prognosis was not favourable, as the disease had 
extended very rapidly in a short time, and the patient had suffered from 
dyspnoea for the preceding five years, in consequence of a neglected pneu- 
monic attack. Ordered to be freely bled and leeched. 

On the 23d she was much relieved; the breathing easier and not more fre- 
quent than 36 or 40 times in the minute; the sputa less streaked and coloured 
with blood. The exploration of the chest gave the same signs as yesterday. 
Venesection to be repeated, and blood to be drawn also by cupping over the 
fossa infra-spinata. On the 24th, respirations only 28 to 32 in the minute; 
sputa thin, mucous, and transparent; the bronchial souffle, bronchophony, and 
egophony well marked. On the 25th the ear began to hear the "rale de retour" 
at several points. On the 26th patient not so well; the crepitating rale heard 
yesterday, no longer appreciable; the breathing and the pulse increased in fre- 
quency. Ordered to be bled. On the following day, the crepitating rhonchus re- 
turned, and gradually, but slowly, the respiratory murmur was to be heard; the 
resonance of the voice also was heard faintly on the 4th or 5th of October; but 
the sound on percussion still remained very dull. 

Case III. Pleuropneumonia of the left side, in the second stage, accompanied 
with typhoid symptoms. — P. B., aged twenty-seven, of a feeble and unhealthy 
constitution, was admitted into the hospital on the 28th of September, with all 
the symptoms of inflammation of the lungs — the breathing 40 times in the mi- 
nute — sputa frothy, transparent, and very rusty. Dullness on percussion over 
the fossa infra-spinata. Vesicular respiration superseded by a bronchial blow- 
ing; — voice also broncho and egophonic, especially along the base of the sca- 
pula. To be largely bled. On the following day slight crepitating rhonchus at the 
lower angle of the scapula, and this was more distinct on the 30th. The pa- 
tient was bled on both days. On the 1st of October a strong crepitating rhonchus 
was heard over the supra- spinous fossa, and over the lower third of the infra- 
spinous fossa. The bronchial respiration and voice still distinct along the base 
of the scapula; sound on percussion dull; sputa viscid and rusty. Venesection 
and leeches to be repeated. 

2d. The pulmonic symptoms aggravated, and the patient lay on his back in a 
state of great depression. To be cupped and blistered. 3d. Breathing very 
laborious, 44, and accompanied with violent action of the nostrils. — Cough fre- 
quent; sputa frothy but not rusty. Bronchial respiration below the left clavicle. 
To be bled to three cups. The clot small, and slightly buffed. He was re- 
lieved; and on the 5th, a crepitating rhonchus was heard over all the extent of the 
supra, and infra-spinous fossse. On the 6th the respiratory murmur began to be 
blended with the crepitating rhonchus; and this latter sign was appreciable in the 
left axilla; and the sound on percussion was more sonorous. — From this date the 
symptoms continued to abate, and the breathing gradually resumed its normal 
characters. — Journ. Hebdomadaire, No. 113. 

27. Dysphagia. — The 8th No. of the Dublin Journal contains the following 
interesting case related by Dr. Graves. " On the 1st of last September I was 
called to see a young lady, who was represented to be in a state of imminent 
danger. On entering the room, I found her sitting up in bed, surrounded by 
several female friends, all in the greatest alarm. Her face was pale, and her 
countenance indicated a good deal of anxiety. She held in her right hand a 
cup containing water, which she applied to her lips about every five seconds, 
and sipped an extremely small portion of the water, which she immediately 
swallowed with a considerable effort of deglutition, although the quantity was 
so trifling; she said that she should be immediately choked if she discontinued 
this perpetual sipping, and she referred to an intolerable uneasiness at the root 
of her tongue and in her throat, threatening immediate suffocation the mo- 
ment she ceased to employ herself in swallowing; and so urgent was the feel- 
ing that impelled her to this act, that the moment an attempt was made to take 
No. XXV.— Nov. 1833. 22 



246 QUARTERLY PERISCOPE. 

the cup out of her hand, she began to scream with agony, was agitated with 
convulsions, and to all appearances seemed in the last agony. This scene had 
lasted for several hours without interruption, and the appearance of the prin- 
cipal actress was rendered still more tragical by a black mass of leeches around 
her throat, and the blood from their bites trickling down her neck. On ex- 
amining her more closely I found that there was no obstruction whatsoever to 
the passage of air through the larynx, and that she could make a full inspira- 
tion, without any wheezing or noise in her chest; there was no swelling or red- 
ness observable at the root of the tongue, or in the fauces. As the young lady 
was of an extremely delicate and nervous habit, being very sedentary and sub- 
ject to frequent attacks of common hysteria, I immediately conjectured that her 
present symptoms were the result of an hysterical affection, and accordingly I 
removed the leeches, stopped the bleeding as soon as possible, and gave her 
draughts consisting of camphor, aromatic spirit of ammonia, and black drop, 
under the influence of which the nervous irritation soon subsided, and she fell 
asleep." 

Dr. Graves makes mention of two other cases of, apparently, nervous dys- 
phagia. A nervous young clergyman consulted him last year on account of 
debility and dyspepsia, accompanied with a painful and convulsive struggle, 
as he expressed it, which sometimes took place between the morsel he had 
swallowed, just before it entered the stomach, and a something that seemed to 
resist its further passage downwards. This lasted for a few seconds only, but 
was very distressing to himself and the spectators, and made him shun society. 
The other case is that of an excellent anatomist, in whom these sudden attacks 
of temporary dysphagia have become so habitual that he never ventures to eat 
unless a glass of water be within his reach; in him, the stoppage of the descent 
of the food is attended with an urgent sense of suffocation. 

"In fever I have witnessed several times a very peculiar species of dyspha- 
gia, evidently occasioned by flatulent distension of the stomach to such an ex- 
tent that the lower portion of the oesophagus partook of this condition; at least, 
I conjecture so, for during the struggle of the dysphagic paroxysm, a gurgling 
noise was heard, as if the bit of food was met by a portion of air contained in 
the lower part of the oesophagus; my friend, Doctor Autenrieth, of Tubingon, 
has particularly remarked this symptom, or at least something like it, in what 
he calls the abdominal typhus fever of young people; for he says, if the patient 
takes any drink a peculiar gurgling noise is heard as if the fluid was poured 
into a lifeless bag. Now, in precisely such a case, Mr. Rumly and I saw a young 
lady affected, in addition to this noise, with so great spasmodic dysphagia, pro- 
bably from the entrance of wind into the lower end of the oesophagus, that she 
altogether refused to drink. This phenomenon gradually disappeared, and the 
lady ultimately recovered; but it deserves to be remarked, that in general this 
symptom and the gurgling noise, described by Dr. Autenrieth, are very bad 
omens in fever." 

28. Use of Turpentine in Sciatic Neuralgias. — M. Martinet has adduced a 
long catalogue of cases to show the superior efficacy of small doses of the oil of 
turpentine. To prevent its acrid effects on the stomach and bowels, he recom- 
mends that it be always blended with some corrective excipient, such as honey, 
gum arabic, magnesia, yolk of egg, &c. and the dose ordered is a drachm or 
two in divided doses, daily. As a matter of course a correct diagnosis must 
have been previously made, in order that we may be satisfied that there is no 
inflammation or organic disease of the nerves; under such circumstances we 
cannot reasonably expect a cure from the turpentine alone. If the drug vomits 
or purges to excess, opium should be added. In 40 cases of acute neuralgia, 
34 were cured, 5 relieved, and 1 was not benefited. In 31 chronic cases, 24 
were cured, 3 were relieved, and 4 experienced no advantage: 33 of the cases 
treated with the turpentine had resisted other remedies previously employed. 



Practice of Medicine. 247 

The period generally required for the cure was from five to twelve days; in a 
few cases the medicine must be continued longer. Out of 58 cases, 48 were 
sciatic, 3 crural, 4 brachial, and 3 facial neuralgias.— Med. Chirurg. Rev. from 
Bull, de Therapeutique. 

29. Arrest of Pain by a Magnet. — Considerable interest has been excited in 
London by the success said to have been obtained in the treatment of neuralgia, 
tic douloureux, tooth-ache, and other affections of the nerves, by the application 
of the ordinary magnet. The following statement relative to this subject is 
from a recent No. of the London Lancet. It may be proper to remark, however, 
that since seeing this statement, we have ourselves, as have also some of our 
friends, tried the agent referred to in a limited number of cases, but without 
any beneficial results, or indeed any marked effects. 

"Our readers will remember the interesting case of neuralgia of the finger at 
St. Thomas's Hospital, upon which Dr. Elliotson stated in a clinical lecture, 
reported in a former No., that he had exhausted his store of remedial agents, 
without developing a shade of improvement. A more severe case, probably, 
was never subjected to treatment. The man left the hospital for a time, totally 
unrelieved, but soon afterwards returned, when in accordance with a suggestion, 
as Dr. Elliotson has since observed in one of his clinical lectures, of a corres- 
pondent of this Journal, the colchicum autumnale was tried in the case, without, 
however, the slightest benefit being derived therefrom. The sedative powers 
of the lobelia inflata then suggested to the doctor the propriety of giving the 
patient the chance of that medicine. The grounds on which it was employed, 
proved to be in a great measure correctly founded. The man took the lobelia, 
in increasing doses, every hour, beginning with seven drops of the tincture, 
and adding a drop to each progressive dose, until as large a quantity had been 
reached as could be taken without deranging the functions of the stomach. 
Great amelioration of the affection followed this treatment. The patient, who 
was before unable even to cross the ward, or bear the slightest cutting of his 
finger nails, and had become emaciated to the extremest degree, from pain and 
sleeplessness, was soon enabled to walk out of doors, and enjoy many hours of 
rest, recovered his good looks, and became comparatively cheerful. 

"The relief, however, was very far from being either perfect or permanent. 
The continued exhibition of the medicine was demanded to secure any portion 
of rest. 

*' A short time since, however, a new remedial agent presented itself, in the 
form of the magnet. The hospital was visited by, (we believe,) Dr. Kyle first, 
and subsequently by a physician of the name of Blundell, a friend of the former 
gentleman, who followed up the application begun by Dr. Kyle. The lobelia 
inflata was allowed by Dr. Elliotson to be suspended, and the effect of the 
magnet tried. That effect was, we learn, a very decided one; the pain was, 
on every application of the instrument, removed, and continued absent for several 
hours. The distance however at which the operator resided from the hospital 
prevented, and still prevents, the daily use of the instrument, or, the impression 
on the patient's mind is, that it would perform a cure. 

" On Tuesday last, the Dr. Blundell already mentioned, reattended the hos- 
pital, at the hour of Dr. Elliotson's visit, when, in the presence of the pupils 
and our reporter, he drew forth the magnet, and commenced its application to 
the patient's finger. 

"The instrument is of the horse-shoe form, about ten inches in its long axis, 
and five in its short, composed of five layers of metal, the central being the 
longest, and the whole bound with stout riband. The patient was at the time 
apparently suffering considerable pain, and unable to use his hand. The north 
pole of the magnet was gently passed five or six times down the sides and back 
of the middle finger, and then rested on the central joint. The result was, 
such a cessation of suffering, that he could gnash his fingers into the palm of 
his hand with ease and comfort, and he declared himself to be entirely relieved. 



248 QUARTERLY PERISCOPE. 

The power of the instrument, however, did not cease here. Dr. Blundell 
showed that it possessed the means of reproducing the pain in the most intense 
form. The south pole of the magnet was directed along the finger. At the 
third pass the patient began to bite his lip, and close his eyes with an expres- 
sion of pain. At a few passes more his chin was involuntarily buried in his 
breast, and his wrinkled features evinced the acutest suffering. This was al- 
lowed to continue for a few seconds, when the north pole was again presented 
to the finger, and the agony speedily subsided. The spectators then left the 
man with a countenance perfectly tranquil. 

" At the extremity of the ward lay an elderly lady, a martyr to tic douloureux 
in the lower jaw, extending to the ear, and affecting a large portion of the 
head. The disease, she stated, was of more than nine years' duration, and had 
never ceased to afflict her for a day during that period up to her entrance into 
the hospital. Her appearance was proportionably miserable. The magnet had 
also been applied in her case, and with similar advantage, as she stated. On 
the present occasion, it was found on approaching her bed, that she was that 
morning free from pain, and the aid of the magnet was not needed. * But cannot 
you show its power by producing the pain?' inquired a bystander. The sug- 
gestion was acted on. The south pole of the magnet was passed from the cen- 
tre of the chin along the lower jaw-bone up to the ear. At the third pass the 
poor woman indicated that the tic was commencing, and in a few seconds more 
the affection was experienced intensely. The process was then stopped, as 
the experiment was carried far enough to satisfy all present of its consumma- 
tion, and after a brief space the presentation of the north pole wholly freed the 
sufferer from pain. The operator subsequently stated that by continuing the 
passes he could have carried the pain on to the production of delirium. 

" There is a female patient in another ward who had suffered intense tooth- 
ache for three months, when a fortnight since, according to her own evidence, 
which we have no reason to doubt, it was instantly cured by one application of 
the magnet, through the medium of a key, and had not returned in the slightest 
degree up to the period of the visit on Tuesday last. 

" These are very interesting facts. We present them to our readers unaccom- 
panied by comment. The specific name given to his instrument by Dr. Blun- 
dell, is that of ' mineral magnet.' How far its application to disease admits of 
extension, we are at present ignorant." 



OPHTHALMOLOGY. 

30. On the Reproduction of the Crystalline Lens, after the Operation for Cata- 
ract. — In the 14th vol. p. 384, of the Philadelphia Journal of the Med. and 
Phys. Sciences, we gave an account of the experiments of MM. Cottreau and 
Leroy d'Etiolles on this subject, and which seem to prove that the lens was 
reproduced. Similar experiments since tried by Dr. Barkhausen, of Berlin, 
were, however, attended with different results. This subject has been still 
more recently investigated by M. Mater, and the January number of the Ar- 
chives Generates contains a memoir from him in relation to it. M. Mayer examin- 
ed the eye of an old woman, on whom the operation of couching had been per- 
formed several years previously. There was no trace of the depressed lens; the 
vitreous substance occupied its place, and immediately behind the anterior wall 
of the crystalline capsule, was observed the posterior wall or layer with the vi- 
treous humour pressing forwards upon it. The following experiments, among 
many others, were performed by M. Mayer. The lens was extracted from the 
left eye of a rabbit, which was killed three days afterwards. No trace of a new 
lens was found at this period, nor on the fourth, fifth, sixth, or seventh days; 
but on the eighth, the crystalline capsule contained a small ring of crystalline 
substance, which could be separated from the capsule. At the end of one 



Ophthalmology. 249 

month a large ring of crystalline substance occupied the place of the removed 
lens. In another rabbit, examined about the same time after the operation, a 
large white annular lens, with an opening in the centre, was found in the cap- 
sule, which adhered to this new lens. In eight weeks the new crystalline pre- 
sented several white granular points arranged in a circle, having an opening in 
the middle; and in four months and a half it was not yet completely regenerat- 
ed; for it was deficient at the centre, leaving there a rounded aperture, at the 
place where the capsule had been cut during the operation. 

Soemmering has given us an account of four dissections, at different periods 
after the operation on the human subject. 

In the first, the patient had been couched eight years and a half before his 
death. In the place of the crystalline capsule two semilunar whitish cheesy 
formations were formed, attached by their peripheral margin to the zonula Zin- 
nii, and floating free at the inner margin; they were doubtless the remains of 
the crystalline capsule. The new crystalline was transparent, gelatinous, and 
imperfectly formed. The former one had been completely absorbed, but a 
small piece of the original capsule was found imbedded in the vitreous humour. 

Case II. Three months after Couching, — In the place of the former lens Soem- 
mering observed an annular transparent gelatinous deposit, imperfect at the 
centre, which was occupied with a fine, almost diaphanous and arachnoid mem- 
brane, situated right behind the pupil, and forming a septum between the aque- 
ous and vitreous humours. 

Case III. Two years after Couching. — Similar appearances were discovered. 
A ring of transparent substance, of the consistence of jelly, in the situation of 
the lens of the left eye; in the right one, which had been also operated on, the 
new deposit was only semicircular, the upper part of the circle being deficient. 
Probably the cause of this was that, during the operation, the upper half of the 
capsule had been completely torn from its adhesions. 

Case IV. Three years after Couching. — The annular " renflement," or new 
deposit, had been very regularly formed? it was slightly and equally convex on 
both its surfaces, and was quite free from any adhesions to the uvea. 

It is to be kept in mind that in order to display the annular crystalline sub- 
stance the eye must be immersed in strong alcohol, by which the new deposit is 
rendered slightly opaque. Soemmering was at first puzzled to determine 
whether it was really a substitute for the removed lens, or was merely a product 
of inflammation; but he was speedily satisfied that the former was the case. 
Sometimes the ring is imperfectly formed; and in other cases we find only iso- 
lated points or grains. These cannot be the debris of the original cataractous 
lens, as some have imagined, for the simple reason that these grains are per- 
fectly transparent, and the cataract was opaque. The preceding facts suffi- 
ciently show that there is a reproduction, although an imperfect one, of the crys- 
talline lens; but we have reason to believe that an indispensable condition is a 
sound and healthy state of the capsule, and especially of its front layer; if this 
be either much torn and destroyed, or if it be rendered opaque by disease, there 
is no regeneration of the crystalline. In all probability, the secretion of the new 
substance is chiefly, if not altogether, from the inner surface of the anterior 
wall or layer of the capsule; and as this layer adheres intimately to the contain- 
ed crystalline, no traces of the cavity or liquor of Morgagni can be henceforth 
discovered. The process of regeneration proceeds invariably from the cir- 
cumference to the centre; and is always found interrupted at the place where 
the capsule has been cut, or lacerated during the operation; — the rent in the 
capsule is occupied with cellular substance. Hence the crystalline substance 
is never entirely reproduced, but always presents in the centre, or opposite to 
the injured part of its capsule, an opening which is filled up with a fine cellular 
tissue. The shape of the new crystalline is generally that of a three-quarter 
moon, the horns of which nearly touch each other. In the experiment on the 
rabbit, which was allowed to live for four months and a half after the operation 

22* 



250 QUARTERLY PERISCOPE. 

of extraction, the new crystalline had this form, with a free space in the middle, 
occupied by a cellular web. 

M. Leroy d'Etiolle and Soemmering state that they have found the new crys- 
talline free and unadherent to its capsule; the observations which M. Mayer has 
made do not coincide in this respect with theirs; — it is a point left open for exam- 
ination. It is worthy of remark, that the mass of the new crystalline almost al- 
ways exceeds that of the original; but that the entire eye very generally be- 
comes somewhat shrunk and contracted for some time after the operation. This 
shrinking is found to extend even to the optic nerve, and that, too, beyond the 
decussation as far as the thalamus. It is conjectured however, that in favoura- 
ble cases the eye and its appendages may resume their original volume. 

31. Lisfranc's Treatment of Amaurosis. — First of all we should ascertain 
whether there are any symptoms of inflammatory fulness and activity in the eye 
or head; — as a matter of course, such cases require depletion; when, however, 
we have reason to believe that the disease is one rather of debility, Lisfranc 
strongly advises us to direct our attention in an especial manner, to stimulate 
the frontal and other branches of the fifth pair of nerves by means of repeated 
blistering over the eyebrows and temples. Should this fail, we must endeavour 
to excite the torpid organ by acting immediately on the ciliary nerves, any irri- 
tation of which is speedily propagated to the ophthalmic ganglion and the ori- 
gin of the trigeminus. This is most effectually done by the application of sti- 
mulants to the cornea; and of these stimulants the nitrate of silver in substance 
is the best. The inferior segment of the cornea is to be lightly touched, till 
we perceive a whitish cloud; — the eye is then to be immediately washed with 
water. Considerable pain is felt; the whole apparatus of the eye is put into a 
state of so increased activity, that on the morrow a stranger might suppose that 
our patient laboured under acute ophthalmia. This treatment induces some- 
times vomiting; and as it always occasions temporary contraction of the pupil, 
it must not be employed when there is a tendency to this evil. The operation 
requires to be repeated several times. — Med. Chir. Rev. from Archives Generates, 
Jan. 1833. 



SURGERY. 

32. Fracture of the Os Hyoides. By Dr. Laiesqjte. — This fracture occurred 
in a marine, sixty-seven years of age, who, in a quarrel, had his throat violent- 
ly clenched by the hand of a vigorous adversary. At the moment there was 
very acute pain, and the sensation of a solid body breaking. The pain was ag- 
gravated by every effort to speak, to swallow, or to move the tongue, and when 
this organ was pushed backwards. Deglutition was impossible, the patient could 
not articulate distinctly; and he was unable to open his mouth without exciting a 
great deal of pain. He placed his hand upon the anterior and superior part of 
his neck to point out the seat of the injury. This part was slightly swollen, and 
presented on each side small ecchymoses, one above, more decided, immedi- 
ately under the left angle of the lower jaw. The large cornua of the os hyoides 
was felt very distinctly to the right side, and it could be felt on the left deeply 
seated, by pressing with the finger: in following it in front towards the 
body of the bone, a very sensible inequality near the point of junction of 
these two parts could be perceived. By putting the finger within the mouth, 
the same projections and cavities inverted could be felt, and even the points of 
the bone which had pierced the mucous membrane, &c. were evident. Having 
bled the patient, and placed a plug between his teeth to keep the mouth open, 
the broken branch was brought by the finger back to the surface of the body 
of the bone, and easily reduced. The position of the head inclined a little back, 
rest, absolute silence, diet, and some saturnine fomentations, composed the 






Surgery. 251 

after-treatment. To avoid a new dislocation by the efforts of swallowing, the 
oesophagus tube of Desault was introduced, to conduct the drinks and liquid 
aliments into the stomach: this sound was allowed to remain until the twenty- 
fifth day, at this time the patient could swallow without pain, and began to 
take a little more solid nourishment, and at the end of two months the cure was 
complete. By placing a finger within his mouth a slight nudosity could be felt 
in the place where in the recent fracture the splintered points were percepti- 
ble. — Journal Hebdomadaire, March, 1833. 

33. Case of Death after very painful Injuries. — A man was admitted into the 
Hopital la Charite with an immense tumour on the upper and inner side of the 
thigh. The operation for its removal was very protracted and painful, in con- 
sequence of the deep adhesions to the ossa pubis and ischii. The patient died 
on the third day, in a state of alternate stupor and delirium. On dissection, the 
only morbid appearance observed was an effusion of serum into the lateral ven- 
tricles of the brain. M. Roux stated that in almost all cases where death is 
consequent upon very severe suffering, he has found an effusion of serum either 
between the membranes, especially between the arachnoid and pia mater, or 
in the lateral ventricles. He has very often noticed it in patients who have died 
from burns, and more frequently in children than in adults. — Transactions Ae- 
dicules. 

34. Two Cases of CEsophagotomy. — A soldier, while eating soup, accidentally 
swallowed a bone. He applied immediately for assistance to the surgeon of the 
regiment, and a variety of means was tried to remove it; but all in vain. On 
the fourth day after the accident, he was put under the care of M. Begix. By 
introducing a caoutchouc sound down the pharynx, he found that it passed 
about seven or eight inches, and was then obstructed by a foreign body, which 
was hard, and immoveably fixed in its place; this seemed to be in the oesophagus, 
immediately below the level of the cricoid cartilage. No forceps could reach 
this depth, and the severe pain caused by the firm pressure of a probang, forbad 
any attempt to push the bone down into the stomach. The patient experienced 
much anxiety and distress in his breathing. It was proposed to give him an 
emetic, but the reporter states, that "la deglutition etoit trop difficile, et ce 
plan ne put recevoir d'execution," (the wherefore is not very obvious.) On 
the sixth day, the saliva was mixed with purulent matter; but the bone stuck 
as fast as ever, and now three grains of tartrate of antimony were exhibited^ 
the patient vomited freely, and felt himself relieved; the probe did not, how- 
ever, indicate any favourable change in the position of the bone. The respira- 
tion was moderately easy, and he could swallow fluids with little inconvenience. 
The quantity of pus which escaped from the mouth had increased in quantity 
for some days past. 

As all means to dislodge the bone had been tried without effect, M. Begin 
resolved on the twelfth day after the accident, to attempt its extraction, by 
cutting down upon the oesophagus. An incision was made between the trachea 
and the inner margin of the sterno-mastoid muscle, extending from the ster- 
num, to the upper edge of the thyroid cartilage. The omohyoideus muscle 
was divided across, the trachea drawn to the right side of the wound, and the 
carotid artery, jugular vein, and par vagum, to the left; a branch of the superior 
thyroid required the ligature. On carefully continuing the dissection, a drop 
of pus followed the stroke of the scalpel; a director was then carried deep into 
a large sac, lying close to the gullet, and a bistoury carried upwards and down- 
wards, so that the anterior parietes of the sac were divided to nearly the extent 
of the outward wound; a large quantity of pus mixed with shreds of cellular 
substance flowed out; the left forefinger was now introduced, and the thin in- 
tervening septum of the walls of the oesophagus was distinctly felt; by gently 
rubbing and pressing this, it gave way, and the finger passed into the gullet it- 
self; still no foreign body could be found; a mouthful of drink was given, and 



252 QUARTERLY PERISCOPE. 

this escaped from the wound. The opening in the oesophagus was cautiously- 
enlarged by the bistoury; a large vessel, probably the superior thyroid, sprung; 
the bleeding orifice could not be found, but was at length secured by passing 
a needle fairly round, and thus inclosing a button of the surrounding parts in 
the ligature; the finger being now passed as deep as it could be carried, felt 
the bone, impacted in the tube of the oesophagus, nearly opposite to the upper 
piece of the sternum; a bent forceps was then introduced, and attempts were 
made to lay hold of the bone; but in every attempt, it seemed that the walls of 
the oesophagus got included between the blades. A blunt-pointed tenaculum 
could be used more easily, by inserting it round the lower surface of the bone, 
and then gently dragging it upwards, till at length it was fairly extracted; a 
quantity of pus and of sloughy cellular substance escaped at the same time. 
The operation occupied twenty-five minutes. Absolute abstinence was enjoin- 
ed, and the mouth was only moistened occasionally, to relieve the thirst; on the 
following day, an elastic gum tube was passed into the stomach, and some 
broth given. The progress of the case was altogether most favourable; the 
wound gradually healed, the food ceased to escape by the orifice, and the pa- 
tient ultimately quite recovered. 

Case II. B. J. was brought to the hospital on the 30th Feb. 1831. On the 
preceding day he had swallowed a bone, which stuck in the gullet, and could 
not be removed. An emetic had been given, and although free vomiting was 
induced, no benefit followed. So firmly was it impacted, that no tugging 
with forceps, or with probangs passed beyond it, was of any avail. It did not 
altogether block up the tube, for small probangs, or rather probes curved at 
the end, might be introduced further down than it lay, although with some dif- 
ficulty; considerable purchase might therefore be employed, during the with- 
drawal of these; but in spite of every effort, the foreign body could not be dis- 
lodged. The respiration and deglutition being easy, the surgeons were un- 
willing to resort to an operation at present, as there were good grounds for ex- 
pecting that the bone might be gradually loosened, if not by the motions of the 
canal, at least by suppuration. But these hopes were speedily found to be fal- 
lacious, and the patient suffered such distress that he was urgent that some- 
thing be done for his relief. On probing the oesophagus, it was thought, that 
the bone had descended somewhat, as it could not be seized so easily as hitherto 
with the forceps. M. Begin therefore resolved to operate, and the operation 
was performed on the eighth day after the accident. The steps of it were very 
similar to those in the preceding case; the integuments were freely divided, the 
trachea and oesophagus separated from the sheath of the great cervical vessels, 
and then the finger introduced deep into the wound; the bone was felt through 
the walls of the gullet, somewhat below the level of the upper edge of the 
sternum. The bistoury was carried along the finger as a probe, in order to 
avoid any injury to the inferior thyroid vessels, and a small opening was made 
into the oesophagus; this was gradually enlarged, till the finger could enter 
freely into the tube; the bone being now felt distinctly, a pair of long and 
curved forceps was introduced, and with much difficulty the bone extracted. 
Not above two table-spoonfuls of blood were lost. 

The subsequent treatment was the same as had been so successfully adopted 
on the former occasion; all the food was introduced by means of a stomach tube. 
On the fourth day, a healthy suppuration was established, and the wound slowly 
closed. He was discharged in six weeks perfectly well. — Med. Chirurg. Rev. 
from Journ. Hebdom. April 1833, No. 135. 

35. Notice of Jlcqua Binelli, with an Account of some Experiments made to il- 
lustrate its supposed Effects. — This is the title of a very interesting article, by 
Dr. John Davy, in the Edinburgh Med. and Surg. Journal, for July last. In our 
preceding number, p. 535, et seq. we published an account of some experi- 
ments made with this liquid at Berlin, and which were highly favourable to its 
efficacy in arresting external hemorrhage. The investigations of Dr. Davy tend 



Surgery. 253 

to disprove entirely the hemostatic powers ascribed to the liquid by the German 
experimentalists, and the known sagacity and intelligence of Dr. Davy entitle 
his observations to every confidence. The properties attributed to the liquid 
under notice, by Binelli, and those who prepare and vend it at present, are not 
a little marvellous, such as the stopping both internal and external haemorr- 
hages, and even of the large arteries when cut transversely — the cleansing 
and healing of all kinds of wounds — the renewal of uterine evacuations when 
suppressed, and the moderating them when excessive, &c. The following is 
Dr. Davy's account of his investigations into the properties of this fluid. 

"I first examined into its physical and chemical qualities. It proved of the 
same specific gravity nearly as distilled water. It was neither acid, alkaline, or 
saline. Its odour was not unlike that of coal-gas not purified, which is lost by 
boiling. Its taste was rather pungent, not in the slightest degree astringent; 
in brief, it appeared to be merely water, containing a little volatile oil or 
naphtha, and was probably prepared by the distillation of water from petro- 
leum, or some kind of tar. 

"I next made trial of it as a styptic. I scratched the back of the hand with 
a lancet till the blood flowed. The water applied to the scratch rather increased 
the bleeding than stopt it. The following morning, in shaving, the razor in- 
flicted a slight cut: the Acqua Binelli was again applied, and the result was the 
same. 

" These few and simple trials were made in January, 1831, just after I received 
the water; and they of course convinced me that the thing was an imposition 
on the public, and deserving of no further investigation. 

" A short time since my attention was recalled to the subject by a medical 
practitioner of this island, who had studied at Naples, inviting me with others 
to witness the effects of a preparation made in imitation of the Jkqva Binelli, 
and which he maintained was identical with it in composition and virtues. 

"The experiment he invited us to witness appeared an unobjectionable one, 
namely, the partial division of the carotid artery of a goat, the bleeding of which 
he undertook to stop by means of his fluid. He allowed us to expose the ves- 
sel and cut it across; about one-half of the circumference of the artery was di- 
vided, and the bleeding was most profuse. He stood ready with compresses 
moistened with the fluid, which he instantly applied one over the other, and 
secured them by rolling a bandage about the neck, making moderate pressure 
on the wounded vessel. A little oozing of blood followed, which soon ceased. 
He said that in three hours the bandage and compresses might be removed, 
without any renewal of the haemorrhage. Accordingly, at the end of three hours 
they were removed; but when the last compress was raised, the bleeding broke 
out as furiously as at first, and, to save the life of the animal, the artery was se- 
cured by ligature. On examining the last compress, a small coagulum of blood 
was found adhering to it, just the size proper to close the wound in the caro- 
tid; thus accounting for the ceasing and renewal of the bleeding. 

" Reflecting on this result, and considering the chemical nature of the fluid 
employed to moisten the compresses, which appeared analogous to that of Bi- 
nelli, the conclusion I arrived at was obvious, namely, that, had the compresses 
used been moistened merely with common water, the effect would have been 
the same, — the bleeding would have been stopt; and it also appeared very pro- 
bable, that, had the compresses been allowed to remain undisturbed, there 
would have been no renewal of the bleeding. 

" To ascertain the truth of these inferences, the following experiments were 
made. 

" On the same day, February 8th, in the presence of several medical officers, 
I divided partially transversely, the carotid artery of two dogs; one small and 
feeble, the other of moderate size and strong. In each instance, the bleeding 
was most profuse till compresses dipt in common water had been applied and 
secured by a bandage, which, as in the case of the goat already given, com- 
pletely stopt the haemorrhage. 



254 QUARTERLY PERISCOPE. 

" The small dog, from the proportionally large quantity of blood which it 
lost, was very feeble immediately, and appeared to be dying; but it presently 
rallied, and for several days seemed to be doing well. It unexpectedly died 
on the 15th, seven days after the infliction of the wound. The bandage during 
this time had not been touched, and no application had been made. Now, on 
exposing the neck, the wound was found covered with coagulable lymph dis- 
charging pus; and, on dissecting out the artery and eighth nerve contiguous to 
it, a mass of coagulable lymph appeared lying over the wound in the vessel, ex- 
tending about half an inch above and below it. This mass of coagulable lymph 
having been carefully removed, and the artery slit open, the vessel was found 
quite pervious, — not in the least contracted. The wound in the fibro-cellular 
tissue, or external coat, was closed by a minute portion of dense coagulable 
lymph. But not so in the middle and inner coat; in these there was a gaping 
aperture, across which, on minute inspection, two fine threads, apparently of 
coagulable lymph, (as if the commencement of the healing process,) were ob- 
servable. The cause of the dog's death was not discovered. 

" The other dog did not appear to suffer from the wound. The bandage and 
compresses were removed on the 15th February without the occurrence of any 
bleeding. On the 20th of the same month, the wound in the neck was nearly 
closed by granulations. The artery was now exposed by incision; and the por- 
tion that had been wounded taken out, between two ligatures previously ap- 
plied. On careful examination of this excised part, it was found free from co- 
agulable lymph, at least there was not the same thickening or tumour from 
lymph deposited, as in the former case; it was probably absorbed. When the 
external loose cellular tissue was dissected away, a very minute elevation, about 
the size of a pin's head, appeared on the site of the wound, the remains of the 
cicatrix externally. The artery was completely pervious, and not all contracted 
where it had been wounded. Slit open for internal examination, the wound 
in the inner coat was marked by a red line interrupted by two white spots; 
there was no gaping; the edges adhered together, excepting at one point; 
elsewhere the union was complete. The white spots resembled the natural 
lining membrane; and had the whole wound been similarly healed, I believe it 
would have been impossible to have traced it. 

"The general results of these experiments, (if I may be allowed to speak so 
of so small a number,) are not without interest in application to surgery. They 
show how a haemorrhage from the wound of a large artery, which by itself 
would be speedily fatal, may be easily arrested by moderate compression through 
the means merely of several folds of linen or cotton moistened with water; and 
they further show how, under this moderate compression, the wound in the 
artery heals, the vessel remains pervious, and without the formation of an aneu- 
rism; and how, after a time, only slight traces of the wound are discoverable. 
Under this moderate pressure the healing of the wounded artery seems to be 
very analogous to that of a wounded vein, and apparently by means of the same 
natural process. 

" Whether similar results could be obtained, were trial made of the same 
means in the wounds of arteries in the human subject, can only be ascer- 
tained positively by judicious experiments. — The probability is that the results 
would be the same. The analogy is very complete, and some facts well known 
in surgery accord with it, not to mention the experience of the effects of the 
JLcqua Binelli, as certified by men of high respectability. 

" It was my intention to have given a selection of the certified cases in favour 
of the Acqua Binelli, brought forward in the pamphlet which is furnished with 
the water. But on reconsidering them, it appeared a superfluous labour, as the 
results, (giving them credit for correctness,) however excellent in a curative 
point of view, are no more than the enlightened surgeon of the present time 
may readily admit to be owing to water dressings alone, without the aid of pres- 
sure, — the majority of instances adduced being examples of gun-shot wounds 



Surgery. 255 

cessity, according to the ordinary mode of surgical treatment, for securing- 
wounded vessels. 

"1 have laid stress on the effect of the pressure afforded by the wet com- 
presses applied in the experiments related, believing that the virtue of the 
means consists in the pressure, — of course not in the water, excepting so far as 
it renders the compresses better fitted for adaptation to the wound to produce 
the degree of resistance requisite to counteract the heart's impulse in the ves- 
se l ; — a nd also better fitted to exclude atmospheric air. I would also lay stress 
on the moderate degree of pressure that is produced in the manner described, — 
allowing the blood to pass through the canal of the artery, and, as before ob- 
served, doing little more than resisting the momentum of the blood in its pas- 
sage from the moving source. 

"The importance of this moderate degree of pressure, which has the effect 
of reducing as much as possible the wounded artery to the condition of a wound- 
ed vein, is, if I do not deceive myself, very considerable. When I have pressed 
with the fingers forcibly on the compresses applied to the wound, expecting at 
the moment to arrest the bleeding, I have been disappointed. The haemor- 
rhage has continued; and it only ceased when the compresses have been se- 
cured, and not tightly, by a roller passed round the neck of the animal. And, 
further in illustration, I may remark, that I have been equally disappointed in 
using graduated compresses, insuring considerable pressure on the wound. 
This means has failed, when general moderate pressure effected by compresses 
about two inches long and one wide, succeeded. 

" On considering the comparative circumstances of these two modes of ap- 
plying compression, therefore, the difference of result is perhaps what might 
be expected. The severe pressure can hardly arrest the bleeding except by 
pressing the sides of the vessel together and closing the canal, the accomplish- 
ment of which requires a most nice adaptation, and a force which cannot easily 
be applied with steadiness except by mechanical means, and in situations af- 
fording firm support beneath. 

" Should the expectation which I have ventured to form of this method of 
stopping the bleeding of wounded arteries of a large size in man be realized on 
trial, I need not point out how very useful it may prove in military surgery, — 
how very available it will be in the field and in battle, especially in great 
actions, when, however numerous and well-appointed the medical staff of an 
army, the number of wounds requiring attention must always exceed the means 
of affording adequate surgical relief, according to the plan of treating them at 
present in use, of suppressing hemorrhage by ligature. 

" I have said nothing of the boasted efficacy of the Jcqua Binelli given in- 
ternally. I trust it is as little necessary to make any comments on it now-a-days, 
as on the tar-water of Bishop Berkeley, so very analogous in nature and reputa- 
tion. Both the one and the other in some cases may be serviceable; but their 
principal recommendation appears to be, that in doubtful cases they are inno- 
cent." 

36. On the various Sorts of permanent Flexion of the Fingers, and of their diag- 
nosis. — 1. The first that we shall mention, is that which is caused by a con- 
traction, or puckering of the palmar aponeurosis. Dupuytren has the merit of 
having first distinctly pointed out the true nature of this affection, and of the 
treatment which it requires; namely, the section of this strong aponeurosis. 

2. A permanent flexion of one or more fingers may be the result of some dis- 
ease or malformation of their joints. 

Case. — A young man had white-swelling of the ankle-joint. The little finger 
of the left hand had been permanently contracted in the form of an arch, from 
his infancy; the phalanges did not move, the one upon the other; but there 
was free motion between the finger and the metacarpal bone. No hard cord 
or projection was felt in the palm at the root of the little finger, when this was 
forcibly bent backwards, or extended. In short, the permanent flexion in this 



256 QUARTERLY PERISCOPE. 

case arose from an anchylosis of the phalanges. In some cases it is produced 
by a synovial cyst forming" over one of the joints; this mishap is not very unfre- 
quent among- tailors; in others by an irregularity, or unevenness of the articular 
surfaces of the phalanges. We observe such cases among tailors, seamstresses, 
and especially among knitters. In them a contraction of the little finger is not 
uncommon, and it proceeds from some abnormal change in one or other of the 
joints. 

Case. — A young female, who worked in the manufactory of lace, applied to 
Dupuytren, to relieve her of a contraction of the four fingers of both hands 
upon the palms; they were bent so as to form nearly a quadrant of a circle. 
The phalango-metacarpal joints were quite free; when the first phalanx was 
strongly bent backwards, no tense tendon or cord was to be felt. 

3. A third variety of the affection is, when it is caused by a division of the 
tendons of the extensor muscles. A person applied to Dupuytren under the 
following circumstances. The two last fingers were constantly bent upon the 
palm of the hand; yet on extension, they could be readily made even with the 
others; but no sooner was the extension withdrawn, than the fingers again be- 
came bent. While extended, no hard cord was to be felt on the palmar, or on 
the palmar surface of the finger; and moreover, each joint might be easily 
moved. The patient had received a sabre cut on the back of the hand, and the 
tendons of the extensors had been divided. Nothing could be done for him. 

4. A puckered cicatrix of the skin will sometimes cause flexion of the cor- 
responding finger or fingers; hence the importance of keeping the hand ex- 
tended during the healing of any wound, sore or burn. 

5. A lesion, or injury of the tendons of the flexors may have the same effect. 
This variety is apt to be confounded with, and mistaken for the first, or that 
which results from a contraction of the palmar aponeurosis: but in the latter 
case, the finger cannot be made to yield to any extension, and the tense cord, 
which was not to be felt before, is now readily recognised during the effort. 
When, on the contrary, the malady has been caused by an injury of the tendons, 
the projection, which was very distinct while the finger is bent, becomes much 
less so, or altogether disappears when it is forcibly stretched. An example of 
this variety is detailed: a tumour had been excised from the finger, and during 
the operation the sheath of the tendon had been opened. 

6. This last species of permanent flexion of the fingers is that which arises 
from the loss or wasting of the substance of the flexor muscles. This may be 
destroyed by a gun-shot wound of the fore-arm, or by laceration, from any 
violence. In such cases there is always more or less paralysis, in consequence 
of the injury done to some of the nerves. The different joints of the fingers 
remain quite flexible; but when they are forcibly extended, pain is felt at the 
cicatrix of the wound. 

It must be altogether unnecessary to state that these different varieties of the 
above malady require different modes of treatment, according to the nature of 
the exciting cause. — Med. Chirurg. Rev. from Journ. Cornp. Sept. 1832. 

37. Formation of Callus, and the Means of Remedying it ivhen Vicious or De- 
formed. By Baron Dupuytrest. — There is, perhaps, no subject in pathological 
anatomy, which has more exercised the sagacity of observers, and the imagina- 
tion of those who establish hypotheses without requiring either observation or 
experience, than the theory of the formation of callus. In recent times, two 
opinions have especially prevailed — namety, viz. those of Duhamel and Bor- 
denave. The first attributed the consolidation of fractures to the swelling of 
the periosteum and medullary membrane, to their extension from one fragment 
to the other, and to their subsequent reunion and ossification. He admitted 
that this reunion took place sometimes by means of a single external clasp, some- 
times by a double one — one of which enveloped the periphery of the fragment, 
while the other entered the medullary canal, where it formed a kind of mortice 
of greater or lesser length. Bordenave established other principles. He admits 



Surgery. 257 

that the reunion and consolidation of fractures, takes place by the same me- 
chanism as the reunion and cicatrization of wounds and soft parts. To this con- 
clusion he was doubtless led by what takes place when the fractured surfaces 
are exposed to the air. He believed that he perceived cellular and vascular 
granulations between the fragments of the fractured bones. According- to him, 
these granulations, being approximated, become, subsequently, solidified by the 
accumulation of calcareous phosphates in their interior. These two doctrines, 
more or less modified, were adopted up to the time when I undertook, in 1808, 
to verify the ideas of Bichat and Bordenave. But I was astonished to find 
nothing to justify them. I multiplied my researches, and was led by my 
numerous experiments to establish a theory partly founded on that of Duhamel, 
and which I have since taught in my courses of pathological anatomy. 

If we examine the parts injured in fracture, from the first to the tenth day, 
we find an effusion of blood about and among the fragments, and even in the 
medullary canal. This ecchymosis may extend to very distant parts. Consi- 
derable inflammation and engorgement take place. The fleshy fibres are con- 
founded with the inflamed cellular tissue, and shortly cannot be distinguished 
from the other parts. The periosteum becomes red, then pale; it swells, then 
softens, and discharges between it and the bony parts a reddish serous-like 
fluid. The fibrous net-work of the parietes disappears. The medullary tissue 
itself swells, inflames, and gradually effaces the canal in the centre of the bones. 
The marrow becomes fleshy to a certain degree, and unites with that of the 
opposite side. If we examine what takes place in the fragments, we see the 
clot which separates them reabsorbed in a few days, and replaced by a gelatine- 
form liquid. From the fourth to the sixth day the surfaces of the fracture are 
covered with a reddish, downy substance, which, however, is not invariably 
present. From the tenth to the twenty-fifth day the swelling of the soft parts 
becomes more solid, its adhesion to the intermediate substance between the 
fragments every day more intimate, the muscles, too, resume their aspect and 
functions. The tumour, which I have named the " callus tumour," diminishes 
in extent, and parts from the surrounding tissues. Its structure is homogeneous, 
like fibro-cartilage, and with difficulty divided. When detached, it is seen to 
be formed by fibres parallel with the axis of the fractured bone. The medul- 
lary membrane, swollen and transformed into a fibro-cartilaginous tissue, nar- 
rows, progressively, the central cavity of the bone, and ends by entirely obli- 
terating it. The inner mortice resulting from these organic elaborations, min- 
gles, on a level with the fracture, with the substance intermediate to the frag- 
ments. 

As we advance in the examination of the formation of callus, we observe 
other peculiarities, which may last till the fortieth, or even the sixtieth day. In 
weak subjects, the formation is only completed in three months. The larda- 
ceous and fibrous mass which constitutes the " callus tumour," and which com- 
pletely envelopes the fractured pieces, becomes by degrees cartilaginous, and 
rather bony. About this time the fragments are sunk into the centre of a solid 
clasp, which adheres all round, and which is externally covered by a thick pe- 
riosteum, united with that ensheathingthe sound bones. No external traces of 
the solution of continuity now remain. The cellular tissue is still stiff and con- 
densed. The soft substance between the fragments hardens and adheres to 
them more firmly, although it is still far from effecting a perfect union. The 
central mortice continues to extend itself towards the extremities, augments 
rapidly in consistence, and soon forms a very solid osseous cylinder. At this 
period the bandages are generally removed. But this callus is not destined to 
remain, for which reason I have termed it the " temporary callus." 

From the third to the fifth or even sixth month, the " callus tumour," and 

central mortice become more compact. The intermediate substance is ossified, 

differing only in colour from ordinary bone. This transformation I have called 

the "definitive callus." In the last period of the change, the central mortice 

No. XXV.— Nov. 1833. 23 



258 QUARTERLY PERISCOPE. 

is rarefied, cells appear in its interior, and it changes into a reticular tissue, 
which itself soon disappears, leaving- the canal completely free. At first, a me- 
dullary membrane lines the cells, and after the reopening* of the canal, it be- 
comes continuous with its lining- membrane, and also secretes a marrow. The 
external portion of the callus also disappears at length. One may readily under- 
stand that the various dispositions of fractures, occasion slight varieties in that 
of the callus. Thus, when two fractured bones mount on each other, the in- 
terior clasp does not exist. The same takes place when there is no medullary 
cavity. 

To sum up; — the reunion of bones in ordinary fractures offers the following 
phenomena: — 1st. Effusion of blood, and a viscous and glutinous fluid between 
the fragments. 2d. The formation of an ecchymosis in the surrounding tissues. 
3d. The formation of a cartilaginous bony external clasp, and the development, 
internally, of a mortice formed by the tumefied medullary membrane, which 
undergoes the same changes. 4th. Ossification of the intermediate substance 
between the fragments. 5th. Diminution of the "callus tumour," reestablish- 
ment of the medullary canal, and return of all the parts to their natural state. 
We thus see that the period of forty days allowed by many surgeons for the 
consolidation of fractures is far from being sufficient, and especially in oblique 
fractures, and in those where the extremities of the bones overlap each other. — 
Legons Orales, 1833. 

38. Lithotrity. — MM. Double, Larrey and Boyer, presented a report to the 
Academy of Sciences at their meeting of the 8th of June last, on the patients 
treated by M. Civiale in his ward at the hospital Neckar during the past year. 
The derangements in the hospitals produced by the cholera caused a complete 
interruption for a time in the service of the calculous patients confided to M. 
Civiale. He consequently has had but 93 patients, of whom 43 have been treat- 
ed by lithotrity. Of these last, 27 have been completely cured; 10 after sub- 
mitting to different trials of the operation have died, and six remain unrelieved. 
Of 8 other patients operated upon by lithotomy, 5 died and 3 were cured. 
All the others were persons in whom different affections of the bladder had 
simulated a calculous affection without any of them really having a stone. Of 
the total number of patients there were only 2 females, both of whom were 
cured by lithotrity in a few days. Two children, one of nine, the other of 
twelve years of age, have also been successfully treated by lithotrity; but M. C. 
finds it necessary in operating upon children to modify his process of operating. 
Infancy, in many cases, presents a contraindication to lithotrity; M. C. is aware 
of this, and he points out moreover different circumstances in adults and old 
persons, which should lead the surgeon to have recourse in preference to litho- 
tomy, or not to operate at all. — Gaz. Med. June 15th, 1833. 

39. Thirty-one Fractures in one and the same Individual. — There was lately 
in Bird's Ward, Middlesex Hospital, an extraordinary instance of the facility 
with which the bones of the body are occasionally broken and reunited, in the 
person of Eliza M., fourteen years of age, who was admitted April 29th, under 
the care of Mr. Arnott, for fracture of the right thigh, in consequence of a fall. 
This, according to the account of the mother, is the thirty-first fracture which 
her daughter has experienced; and the girl, who is quick and intelligent, states 
the particulars thus: — The right thigh has been broken seven times, the left 
six; the right leg nine times, the left once; the right arm four times, the left 
three; and the left forearm once. 

Eliza M. was about three years of age when the first fracture, that of the left 
leg, occurred from a fall, and she has never fallen since without fracturing a 
limb. But even this is not necessary, for she has broken a bone by merely 
catching hold of a chair, and sometimes in simply turning round suddenly. She 
has a sister six years of age in whom there exists the same susceptibility, and 
who, since the age of eight months, has had nine fractures. In neither of the 



Midwifery. 259 

parents or their families has there been any similar disposition, nor in three 
others of their children, two boys and another girl. 

There is nothing peculiar in E. M.'s appearance. She has delicate features, 
a fine skin, dark hair and eyelashes, and bluish-gray irides. The bones of the 
trunk and upper extremities present no alteration from the natural form, but 
those of the right leg are strongly arched forward, and so is that of the left 
thigh; in a trifling degree this is the case with the left leg and right thigh. Be- 
sides the curve forwards, the bones of the right leg seem to be flattened late- 
rally, as in rickets, but no curvature existed before the bones began to break. 
A variety of medicines were formerly tried in this case, with a view to remedy 
the great brifetleness, (as it has been called,) of the bone; but the mother states 
that she never found them to be of the least benefit. She speaks, however, in 
strong terms of the advantages derived from a residence at the sea-side, and 
nourishing diet. 

No difficulty has ever been experienced in getting the bone to unite — so lit- 
tle that the mother has treated many of the fractures, (those not attended with 
displacement,) herself, and has of late sought surgical assistance only when the 
larger bones were broken. Thus the girl was in this hospital about two years 
ago for a broken thigh, and this interval is the longest she has ever experienced 
without a fracture. 

The thigh bones, and those of the arm, have never broken without displace- 
ment; those of the leg have. It would seem as if, in the case of the latter, the 
fracture had not always been complete. Her health suffering, this girl left the 
hospital on the 28th of May, but Mr. A. mentioned the other day that he had 
since called at the residence of her parents, and found her doing well. The 
limb had been treated on the double-inclined plane with splints, which were 
continued at home. E. M. does not walk without a crutch, and it was in con- 
sequence of this slipping that she met with her last accident; but Mr. A. found 
her sister, who has had the nine fractures, running about without any assistance 
of the kind, and in a state of apparently perfect health. — Lond. Med. Gaz. June 
15th y 1833. 



MIDWIFERY. 

40. Two Cases of Artificial Delivery. By M. Th. Lovati, Professor in the 
Obstetrical Institution of Pavia, extracted from the Clinical Review of that In- 
stitution, for the years 1830-31. — We publish with all the detail which they 
merit, two cases of delivery produced by artificial means; an operation which 
has been condemned, though not without regret in France, and which has been 
performed already eight times in the hospital of Pavia with success. It may be 
as well, perhaps, to remark, that Professor S. does not deserve to be charged 
with temerity in practice, for we find, that in ninety-four cases attended by 
him, he performed the operation of turning but once, and that he manifests 
great dread of the forceps. There are several different methods employed for 
the purpose of effecting premature delivery; Professor Sorati, however, prefers 
the introduction of the sponge to all others, provided there is no urgent neces- 
sity^ for immediate delivery. Professor Billi, of the St. Catharine obstetrical 
institution at Milan, has recently had recourse to this method, and met with the 
greatest success. On the two succeeding cases, a comparative judgment of 
the merits of the two operations, viz. the introduction of the sponge, and the 
puncture of the membranes, may be formed. 

Case I. — First labour. — Pelvis normal in its formation, though exceedingly 
narrow. Artificial delivery brought on in the eighth month, by the introduc- 
tion of a sponge into the cervix uteri. Happy termination of the case. A 
woman, set. 33, in her first pregnancy, of small stature, sanguine temperament, 
and who enjoyed at all times excellent health, was admitted into the Lying-in- 



260 QUARTERLY PERISCOPE. 

Hospital. Upon an examination of the pelvis, it was found that this cavity in- 
clined very much forwards, though with the exception of its being" contracted 
in all its dimensions, it was generally speaking well-formed. The pelvimeter 
of Baudelocque indicated the existence of but three inches six lines in the 
sacro-pubic diameter, and as much in the oblique; it was, moreover, discovered 
by the introduction of the finger into the vagina, that the sacro-vertebral angle 
was nearer the pubis by half an inch, than the pelvimeter had indicated. There 
existed, therefore, a contraction of one inch in all the diameters of the superior 
straight. Under these circumstances it was evident, that delivery at full time 
could not be accomplished without great risk to both mother and child, it was 
consequently determined, that premature delivery by artificial means should be 
attempted. There was some embarrassment in determining exactly the period 
at which the operation should be performed. The menstrual discharge having 
always been irregular, it was impossible to derive from its absence any definite 
conclusion relative to the epoch of conception; and no other phenomena had 
occurred to advertise the woman of her having conceived, it was equally im- 
possible to determine at what period the movements of the foetus had com- 
menced. The only indications, therefore, from which any conclusions could 
be drawn, were the volume of the uterus, the degree of development of its 
neck, and the presenting portion of the foetus. The fundus of the wound ex- 
tended as high up as the lower margin of the epigastric region; its neck, though 
still elongated, was nevertheless, sufficiently dilated to admit the introduction 
of the point of the first finger, whilst its inferior segment, a good deal thinner 
than usual, allowed the head of the foetus, which corresponded in size to the 
degree of uterine development, to be distinctly felt. All these circumstances 
combined justified the conjecture, that the woman was about the eighth month 
of her term, nevertheless, as there existed so much incertitude, and also to af- 
ford the infant a better chance of surviving, it was deemed expedient to defer 
the operation for two weeks longer, inasmuch as the delay, whilst it gave ad- 
ditional strength to the vital energies of the infant, by no means increased the 
difficulties of the operation, for it matters very little whether at this period the 
head increases in size or not, as its imperfect ossification allows it to adapt 
itself to the narrowness of the passage. 

On the 12th October, at 11 o'clock, A. M. the woman having been placed in 
the horizontal position, the professor proceeded to perform the operation in 
the following manner. A small tampon of sponge, an inch in length, and about 
the diameter of a quill, through the centre of which a thread was passed, was 
introduced by one of its extremities into a trocar cannula, in such a manner, 
that the cannula served as a conductor, by means of which the other extremity 
of the tampon could be introduced into the orifice of the cervix uteri. The 
whole apparatus was then placed along the palmar face of the first finger, and 
introduced into the vagina. The extremity of the tampon having penetrated 
the external orifice of the uterine neck, the cannula was seized with the left 
hand, and gradually pushed forward by a sort of rotatory motion, until the 
sponge arrived at the membranous sack. The operator was convinced that 
the entire cavity of the neck was traversed by the tampon, by the sensation 
produced by striking the end of the tampon against the membranes, and by the 
complete absence from pain when this shock was created. In order to remove 
the cannula without changing the position of the sponge, it was only necessary 
to push against the sponge by means of a drill, while at the same time the 
cannula was withdrawn, the thread, an end of which being out of the vagina 
was fastened to the thighs. The operation occupied but a few moments, was 
attended by no hemorrhage whatsoever, and by no more pain than is ordinarily 
produced by the operation of touching. The patient was kept in the horizontal 
position, and to guard against the pain, or convulsions which might ensue, 
from the introduction of a foreign substance into the womb, an emulsion con- 
taining the ext. of henbane, and a light vegetable diet were prescribed. In 
about three hours after the operation, pains of short duration occurring at in- 



Midwifery. 261 

tervals of a quarter of an hour, and which offered all the phenomena of uterine 
contracti«fas, made their appearance. For the next two hours they increased 
in violence, and then gradually diminished until 6 o'clock at night. A slight 
tractive force being* now applied to the thread, the sponge was drawn out. It 
was found to have acquired nearly four times its original bulk, was soft, and 
covered with a thick mucus. Upon examination the neck was found thinner, 
much softer, and both its cavity and orifice sufficiently dilated to admit of the 
easy introduction of the finger, as far as the membranes. There was no other 
change in the parts, and no indication whatever of the existence of irritation. 
A second piece of sponge six lines in length, and two in thickness was now in- 
troduced; the difference in the size of the sponge being" made to correspond 
with the relaxed condition of the cervix uteri. Its introduction was followed 
by the occurrence of violent pains, which lasted until 11 o'clock at night; at 
that hour they ceased entirely, but reappeared at 6 o'clock in the morning-, 
though in a much milder form. Her general health was perfect. Believing 
that this second tampon had performed all that it possibly could, at 8 o'clock 
it was withdrawn, and was found to have increased in its thickness to seven 
lines, and to be covered with a thick inodorous mucus. The cervix uteri was 
found thin, soft, both its orifices more dilated, and the internal to a much 
greater extent than the external one. There was no symptom whatever de- 
noting the existence of either general or local irritation. A third piece of sponge 
eight lines thick was introduced. In an hour after its introduction, the uterine 
contractions recommenced, and about 10 o'clock again became feeble, at 1 
o'clock, P. M. in making an examination of the parts, it was discovered, that 
there existed a slight degree of resistance to the extraction of the tampon; this 
was found to have very much increased in size, in those portions which had 
corresponded to the cavity and internal orifice of the neck, and in a less degree 
in the part previously in contact with its external orifice, the dilatation of which 
was found to be in a less advanced stage than the other parts. A fourth tampon 
similar to the last was now introduced, in one hour afterwards pains both more 
violent, and occurring at shorter intervals, than any of the preceding ones came 
on, and lasted until 8 o'clock, P. M. At this time, during an examination of the 
patient, the sponge fell into the vagina; and it was discovered that the cervix 
uteri had entirely disappeared. The regularity of the pains, the dilatation of 
the cervix under their influence, the tension of the membranes, all evidently 
indicated the first stage of an approaching labour. The external orifice still 
kept up its resistance, and the inferior segment of the uterus its thickness. 
From this period, the woman being considered as in an ordinary labour, was 
permitted to change her position and leave her *bed. The resistance offered 
by the inferior segment of the uterus, together with the trifling nature of the 
pains, prolonged the period of labour to the fourteenth day at 8 o'clock, P. M. ; 
at this time the membranes burst of themselves, and previous to the entire dis- 
appearance of the neck of the womb; this circumstance, joined to the size of 
the head, its inclination backwards and to one side, and more particularly to 
the contracted dimensions of the pelvis, retarded the completion of the delivery 
to the 15th at 1 o'clock, A. M. when it took place, though with great difficulty. 
The infant was born apoplectic, but in consequence of a copious bleeding from 
the cord, was soon restored to animation. Upon examination, it appeared to 
have already passed the eighth month, its length was fifteen inches eight lines; 
the oblique diameter of the head four inches nine lines; the anteroposterior 
four inches; the bi-parietal three inches one line; the perpendicular three inches 
three lines; and the auricular two inches nine lines; its weight was four pounds 
five ounces avoirdupoise. During the first few days after delivery, the mother 
suffered from an attack of bronchitis, for which she was twice bled, she was 
speedily relieved, and in a few days left the hospital with her infant both in 
perfect health. 

Professor Lovati in general prefers the introduction of the sponge in the 
manner we have just described, to the employment of the puncture; the opera- 

28* 



262 QUARTERLY PERISCOPE. 

tion, however, most generally practised. He contends that the latter operation 
renders the labour more difficult, inasmuch as the membranous sack, the utility 
of which in opening and dilating the neck, is well known to every one, is rup- 
tured. Several other methods, such as frictions of the uterus, stimulants ap- 
plied to its neck, separation of the membranes from the internal orifice of the 
neck, have been proposed to bring about the same object, which we have just 
seen effected by the sponge. But of these we may remark, that the first are 
not sufficiently active to effect this end, the contractions which they produce 
ceasing as soon as the cause exciting them is removed; and that the latter is 
accompanied by danger, and exposes us moreover to the inconvenience of rup- 
turing the membranes — a circumstance always to be avoided. The sponge, he 
concludes, gives less pain, and is at the same time more certain than any other 
measure. But when the danger is urgent, the sponge may be too slow in its 
operation; in the following case it will be seen, that under such circumstances, 
the professor did not hesitate to puncture the membrane. A close examination 
of these two cases, in which both the causes demanding an operation, as well 
as the operations themselves, were different; yet in which alike success at- 
tended each, seems to us well calculated to demonstrate in what light artificial 
delivery should be considered, as well as how much its dangers have been ex- 
aggerated. 

Case II. — First labour. — Obstinate vomiting; eclampsia coming on in the 
seventh month; artificial premature delivery produced by a puncture of the 
membranes, attended with complete success. — A young girl, set. 17, of a san- 
guine temperament, and thin habit of body, who had always, by a scrupulous 
observance of a particular regimen, enjoyed very good health, becoming preg- 
nant, also became sad and restless, and was attacked by a series of distressing 
symptoms, the most obstinate of which was continued vomiting. These symp- 
toms increased to so distressing a degree, that a physician was obliged to be 
consulted, who prescribed blood-letting, revulsives, resolvents, and finally 
sedatives, but without producing any beneficial effect. About the middle of 
October, 1830, she was admitted into the hospital in the seventh month of her 
pregnancy. At this period she presented truly a most deplorable spectacle; 
reduced almost to a skeleton; tormented by hunger, without being able to take 
any kind of food; the stomach rejecting every thing, even the remedies admi- 
nistered with a view to her relief, it was with difficulty that life was sustained. 
By administering small quantities of jelly broth, and chocolate made with 
osmazome, so that the little she could retain, consisted of the most nutritious 
articles, she was but barely supported. About the end of October the vomitings 
ceased, and were replaced by violent spasms of the stomach, and convulsive 
movements of the whole body. During the paroxysm her intellectual faculties 
became disordered, the countenance mild, the eyes injected, the jugulars 
swollen, the carotids pulsated violently, and the lips were covered with foam. 
In such a condition it was thought advisable, in the first place, to attack the 
cerebral symptoms; with this view, she was twice bled, the quantity of blood 
taken being proportionate to the strength of her vital powers — great prostra- 
tion, nevertheless, succeeded to the operation, to relieve which, an infusion of 
mother-wort and balsam, with laudanum, was prescribed. This was immediately 
rejected by the stomach. A large blister was then applied to the epigastric 
region, which, by concentrating the disease upon the stomach alone, produced 
a momentary relief. But the advance of her pregnancy, and the debility pro- 
duced by the obstinate vomitings, as well as by the evacuant measures, which 
had been necessarily employed in the epileptic paroxysms, did not permit this 
calm to be of long duration. In a few days the general convulsions returned 
with more violence than ever, at the same time assuming the type described by 
Sauvages under the term of eclampsia puerperalis. Upon the loss of sense, 
and after some moments of complete immobility, violent contractions of all the 
muscles would come on, the body of the patient being frequently made to 
describe an arch backward, the bases of which were the head and feet, pre* 



Midwifery. 263 

senting a most frightful appearance. The limbs were violently extended, and 
the articulations absolutely inflexible, whilst the eyelids remaining half closed s 
left the contracted pupils exposed to view. Then suddenly, the convulsions 
passing from the extensor to the flexor muscles, the whole body was bent up, 
the arms being closely applied to the trunk, whilst the latter was flexed and 
bowed forward. Not a muscle, not a fibre, was exempt from spasm; thus at 
one instant the countenance wore a serious aspect, at the next a smiling one, 
the changes succeeding each other with astonishing rapidity. Vomiting, the 
involuntary evacuation of urine, hiccup, palpitations, and a host of similar phe- 
nomena, complete the assemblage of symptoms occurring during the paroxysm, 
which lasted sometimes as long as two hours and a half. The paroxysm over, 
she generally sank into a state of prostration and distress, that beggars descrip- 
tion. Every part of her body became so sensitive, that the slightest touch pro- 
duced the most excruciating pain, whilst all the voluntary muscles seemed 
stricken with palsy. She remained in this condition several hours, more or 
less, according to the intensity of the paroxysm. As her pregnancy advanced, 
these attacks became more violent, as well as more frequent, and she suf- 
fered from as many as fifteen in the short space of nine days. What now re- 
mained to be done? Blood-letting, as recommended by Mauriceau, Lamotte, 
Levret, Baudelocque, &c. was henceforward impracticable, on account of the 
great prostration of the patient; and antispasmodics, as well as all other internal 
remedies were rejected as soon as administered. Frequent immersions of the 
extremities in warm water during the period of calm, and cold applications to 
the head during the paroxysm, were productive of no effect whatsoever. Thus 
on the one hand, extreme prostration, and on the other, the increasing violence 
of the paroxysm threatened our patient with speedy dissolution; and although 
delivery complicated with eclampsia, in the opinion of the most experienced 
practitio ners, proves very often fatal, yet in the present instance, delivery was 
the only measure that seemed to promise a happy result. By a singular contre- 
temps, the uterus, in the midst of the general convulsion, remained perfectly 
tranquil, apparently experiencing no pain whatever. Experience having taught 
the professor that the general convulsions which occur during pregnancy, are 
very often suspended during labour, and considering moreover that there re- 
mained but this measure to oppose to an affection, which, if suffered to pro- 
gress, would prove fatal to both mother and child, he determined to bring 
about premature delivery. On the 13th of November, at 1 o'clock, P. M. the 
membranes were punctured by means of a sharp-pointed sound, and the whole 
of the liquor amnii evacuated, in order that the uterus might apply itself more 
closely to the foetus, and also be induced to contract in a shorter space of time. 
Nevertheless, no pains made their appearance until 6 o'clock the next evening. 
During this interval of twenty-four hours, but one attack of eclampsia had made 
its appearance. During the labour, several feeble convulsive efforts manifested 
themselves, though fortunately they retained their trifling character, and in two 
hours time, the patient was safely delivered of an eight month's child, alive and 
healthy. With the pregnancy vanished, as if by magic, both the general con- 
vulsions, and those of the stomach, which had continued so obstinately for such 
a length of time. The patient remained in the hospital a few days, in order to 
recruit a little, and then left it perfectly cured. 

41. Employment of Decoction of Belladonna in a Case of Rigidity of the Neck 
of the Uterus. — Dr. Ricker, Director of the Institution for the Instruction of 
Midwives in the Dutchy of Nassau, relates in Siebold's Journal, Vol. XI. No. 3, 
the following case. A woman nineteen years of age, small, tolerably robust 
constitution, who had always menstruated regular, although the appearance of 
her courses had always been preceded by acute pain about the sacrum, became 
pregnant in the spring of 1829. Labour pains came on during the night of the 
31st of December. Dr. R. saw her the subsequent afternoon. He found the 
vagina contracted and dry; the neck of the uterus still high, and entirely obli- 



264 QUARTERLY PERISCOPE. 

terated; and the inferior portion of the uterus so thick that it was difficult to dis- 
tinguish by the touch the head of the infant through it. The mouth of the uterus 
was a quarter of an inch thick; hard, and felt like cartilage. The end of the fore- 
finger could with difficulty be introduced into it. Fumigations were directed 
to the vulva, and the application to the neck of the uterus of a sponge wet with 
a decoction of chamomile. The next day, January 2d, the parts continued in 
the same state? the patient was bled twelve ounces; the contractions of the 
uterus were less painful; at night the os tincae was dilated to the extent of an 
inch, and it was hoped would continue to enlarge, but the next day it was found 
to have remained stationary. A sponge was wet with a decoction of belladonna 
and of marsh mallows, two drachms each, and of four drachms of flaxseed, and 
applied to the neck of the uterus, and renewed every half hour. At the termi- 
nation of three hours, the os tincae had dilated to three inches and a half, but 
as the head advanced slowly, the forceps were applied after some hours, and 
a, vigorous child delivered.— .Sew. Med. Feb. 1833. 



MEDICAL JURISPRUDENCE. 

42. Case of Poisoning by Arsenic. — In a late No. of the Annates d' Hygiene 
Fublique et de Med. Leg. there is an interesting account of an examination of 
bread suspected to contain arsenious acid, by M. Orfixa. That distinguished 
chemist succeeded in detecting the poison by the following method. The 
bread having been cut into pieces was treated with cold distilled water, the 
liquor filtered, and then tested by concentrated liquid hydro-sulphuric acid, 
(solution of sulphuretted hydrogen.) The fluid became instantly yellow, but 
was not sensibly troubled. Some drops of muriatic acid were added to preci- 
pitate any sulphuret of arsenic which might form. The liquid was so little 
troubled, that it would be difficult to suspect what was subsequently to happen. 
In fact it was only after some days that there was deposited a yellow precipitate, 
consisting of the sulphuret of arsenic and organic matter. Had he only waited 
twenty-four or forty-eight hours, no precipitate would have been obtained. 

The precipitate was separated and washed repeatedly in distilled water, then 
placed on a little filter, and washed with ver} r weak ammonia, by which the 
sulphuret of arsenic was dissolved, and the organic matters left. This proceed- 
ing was frequently repeated, the ammoniacal solution then evaporated to dry- 
ness, the residuum mixed with a little charcoal and carbonate of potass. The 
mixture was then toasted, by holding the watch-glass at a certain distance from 
live coals, with a view to decompose any animal matters, which the sulphuret 
of arsenic might still contain. The watch-glass and its contents were then pul- 
verized in a mortar, and the powder introduced into a tube, the upper extre- 
mity of which was drawn out in the spirit-lamp. The part containing the 
mixture was then brought to a red heat, when metallic arsenic quickly ap- 
peared. 

"I should remark," saysM. O. "1st, that it is important when we act on a small 
quantity of matter, to calcine it together with the ground watch-glass, because 
without this precaution we should often fail in detaching the sulphuret of arse- 
nic; 2d, that we must not push the previous torreficatiou too far, lest we decom- 
pose and volatilize the sulphuret of arsenic, or even reduce and lose the metal in 
the atmosphere. In conclusion, I think it my duty to insist especially on the 
process which should be constantly adopted when we endeavour to reduce the 
metal from very small particles of arsenious acid, or of the sulphuret of arsenic. 
The tube should be narrowed and drawn out in the spirit-lamp. The oxyda- 
tion of the metal should also be accomplished by placing the metal in a tube 
open at both ends, and of moderately large size. Metallic arsenic is, moreover, 
recognised, 1st, by its physical properties; 2d, by its garlic smell; 3d, by the 
faculty it possesses of dissolving in warm nitric acid, and affording by the eva- 






Medical Jurisprudence. 265 

poration of the liquid a white mass, which being- dissolved in distilled water 
and treated while warm in a phial with liquid sulphuretted hydrogen, affords 
in a few seconds a yellow precipitate of sulphuret of arsenic, soluble in ammo- 
nia, which deprives it of its colour." 

43. On the Poisonous Properties of the Salts of Lead. — Among the salts of 
lead Dr. A. T* Thomson has endeavoured to show that it is probably that the 
carbonate is the only direct poison; and that the seemingly poisonous proper- 
ties of the other salts of that metal depend on their conversion into this. 

The author commences his inquiry by the detail of a few historical facts, to 
show that the poisonous effects of the carbonate of lead were known at an early 
period, and that the opinions respecting the poisonous properties of the other 
salts of this metal are of modern date. Paracelsus, who introduced the medici- 
nal employment of acetate of lead, administered it in large doses with impunity; 
and instances are recorded in which persons have swallowed from one drachm 
to six drachms of the salt, without experiencing- any injurious consequences. 

He then states some experiments which he made to determine the affinity of 
the different salts of lead for carbonic acid; from which it appears, that sub- 
acetate and citrate of lead in solution have so powerful an affinity for carbonic 
acid, as to take it from the air, and all other substances containing it; that the 
affinity of the acetate for this acid is comparatively weak; and that carbonic 
acid effects no change whatever on the nitrate, muriate, sulphate, phosphate, 
and tartrate of lead. 

The next object of the author was to examine the effect which the three 
salts, convertible into the carbonate, produce upon animals. Eight experi- 
ments upon dogs are detailed, which led to the conclusion that these quadru- 
peds are bad subjects of experiments with the salts of lead. None of the dogs 
died. He endeavours to account for the deaths recorded by Orfila in similar 
experiments on dogs, by suggesting that, as the doses were extravagantly large, 
the irritation excited in the stomach produced inflammation and death, in the 
same manner as common salt or any other salt in excessive doses, independent 
of any poisonous property. He also thinks that some fallacy may arise from 
placing a ligature upon the oesophagus, as under such circumstances the animal 
cannot be considered to be in a natural condition. Eight experiments upon 
rabbits are next detailed. In the first experiment, six grains of nitrate of lead 
in solution were injected into the stomach of a strong young rabbit; no injurious 
consequences resulted, nor did any inconvenience follow the repetition of the 
experiment with nine grains of the nitrate on the following day. Three days 
afterwards, when the same rabbit appeared in perfect health, six grains of the 
carbonate of lead, suspended in mucilage of starch, were injected into the sto- 
mach of the animal. On the following morning he was found dead. The only 
peculiarity perceived, on opening the body, was the turgid state of all the cavi- 
ties of the heart; the blood was slightly coagulated in the right auricle, but it 
was fluid in the other cavities. 

In the fourth experiment, six grains of muriate of lead, in solution, were in- 
jected into the stomach of a strong young rabbit, without being followed by 
any inconvenience. Three days afterwards, six grains of the carbonate were 
thrown into the stomach of the same rabbit, who died on the morning of the 
second day. 

Two other rabbits were treated with seven grains of the acetate and of the sub- 
acetate of lead. No inconvenience followed the administration of the acetate; 
that of the subacetate was followed by dejection and languor, with a disincli- 
nation to move and to take food: the animal, however, was alive at the termina- 
tion of a week after taking the salt; it died in twelve hours after taking- four 
grains of the carbonate of lead. 

The author is disposed to conclude that the subacetate of lead, which ap- 
proaches nearest to the carbonate in its effects, owes its poisonous property to 
its powerful affinity for carbonic acid: he points out the consequences which 



266 QUARTERLY PERISCOPE. 

would result to the practice of medicine, if it should appear that the carbonate 
is the only salt of lead deleterious to the human subject; and remarks that these 
experiments appear to form an exception to the doctrine, that the activity of a 
poisonous salt is in proportion to its solubility. — Second Report of the British As- 
sociation for the Advancement of Science. 



MEDICAL STATISTICS. 

44. On the Bearing of Epidemics upon Medical Statistics, and Political 
Economy. — After a close investigation of the subject, M. Villeume arrives at 
the following- conclusions. "That epidemics diminish both in frequency and 
intensity in those countries which from a state of barbarity, or ignorance pass 
to that of civilization, and also in those which pass from a semi-civilized condi- 
tion to one in which civilization is at its acme. That the lower classes of so- 
ciety being more frequently attacked, consequently more frequently fall victims 
to the epidemic, than the middling classes, or those in good circumstances. 
That in causing the disappearance of epidemics, and in diminishing their force 
and frequency, civilization has attended in a great many situations both the 
maximum and minimum epochs of life, but more particularly the former or 
maximum. That in a given number of patients of all ages, the mortality will 
be found to be much greater in the very young and very old; so that in this 
respect, the laws of epidemic mortality correspond with those ordinarily ob- 
served, it results from this, that those epidemics which attack the two extremes 
of life, are ceteris paribus, the most fatal. That the vaccine has effected 
at least in the thickly populated country of France, nothing more than alter the 
period of death, but in those countries the inhabitants of which are widely se- 
parated from each other, and who possess the means of subsistence in greater 
profusion than is absolutely necessary, it undoubtedly increases the population. 
We should not suppose, however, that it cannot contribute even amongst us, 
in any way to produce this increase. In substituting, during a given period, 
one infant who arrives at the age of maturity, for two who although they con- 
sume, die before they are able to produce any increase, the vaccine favours 
production; and consequently indirectly favours by the employment of its pro- 
ducts, or the means produced by its employment, an increase of population. 
But this effect is very trifling in comparison with that usually attributed to the 
vaccine. All those measures by which the diseases of infancy are warded off, 
operate in the same manner; they moreover in suppressing one of the causes of 
death, lend additional activity to others. That in civilized countries, the most 
fatal epidemics produce but a transient diminution in the population; the va- 
cancies which they create being speedily filled up, both by marriages and by 
births, which are proportionably more numerous than ever, and also by the 
influx of strangers who are induced to come in, by the numerous vacancies pro- 
duced in the different professions, trades, &c. But if epidemics do not com- 
monly diminish the population of those countries which they ravage, or at most 
only for a short period, they at least exert a manifest influence upon the popu- 
lation and its movements; an influence which varies according as the epidemic 
occurs annually, or at larger intervals. In the former case, that is where the 
epidemics are annual, as is the case along the banks of water-courses, or in the 
neighbourhood of marshes, the renewal of the population is observed to be 
more rapid, and the average term of life is shorter; there being very few who 
arrive at adult or old age. The population does not diminish, and for the simple 
reason, that marriages take place at a very early age, and in a given time, the 
number of births greatly exceeds that in other countries. The same space, 
which in a healthy country would be occupied by the same individual during 
a period of forty years, will in one in which the causes operating against lon- 
gevity are particularly rife, be occupied by two or three different persona. 



Miscellaneous. 267 

And in consequence of these fatal epidemics, the average term of life is reduced 
to twenty, and in some places even to thirteen years. But supposing the 
number of individuals to be the same in two different countries, yet their re- 
lative usefulness may be very different; in the one, we may have a poor, infirm, 
sickly population, immense numbers of whom perish previous to the perform- 
ance of any productive act, and who resemble, if we may be allowed the com- 
parison, a capital lost at sea. Whilst in the other, on the contrary, we have 
a robust, strong, vigorous class, who may in truth be termed the bone and sinew 
of the land, and who generally speaking live to an advanced age, or by labour 
obtain every necessary for themselves and families. 

In the second case, or where an epidemic suddenly appears in any spot which 
has heretofore escaped its ravages, or even should it be characterized by unac- 
customed violence in a country which has never been exempt from it, a very 
sensible diminution in the population will be observed, and immediately after- 
wards, ceteris paribus, an extraordinary increase in the number of births 
and marriages; such is the disposition to production at this period, that those 
unions which have remained uninterrupted, and from which no further increase 
was anticipated, have again become fruitful. Finally, not only the yearly num- 
ber of deaths is diminished, but likewise the proportional number, as if in truth 
mankind had become more tenacious of life, or less liable to the attacks of the 
* fell destroyer.' Hence arises the old saying, that * all epidemics of a fatal 
character, are followed by seasons of great salubrity,' every thing, however, 
induces us to believe, that this fact exists only in appearance. We know, that 
the disease attacks generally speaking only weakly or sickly individuals, and 
that it consequently leaves a larger proportion of healthy, able-bodied persons, 
so that although it increases the relative space, it at the same time adds to the 
period of existence of the individuals remaining. Moreover, this latter change, 
whatever may be the cause, always exerts as is well known, a sensible influence 
upon the period of life, as well as upon the number of births."— Archives Gin, 
Dec. 1832. 

45. Mortality in France from Cholera. — It is officially stated that the total 
number, (military excepted,) of those affected with cholera in France from its 
first appearance at Calais, March 15th, 1832, to January 1st, 1833, is 230,000, 
and the deaths 95,000. 



CHEMISTRY. 

46. Jlcids of Nux Vomica. — M. Carmojl has obtained from the mix vomica 
two new acids. One of them exists in combination with lime, with which it 
forms a very soluble salt, which may be purified by successive solutions and 
crystallizations in water and alcohol. This salt dissolved in water, and treated 
with oxalic acid, is decomposed, and an acid differing from the igasuric is sepa- 
rated. The other acid has not been examined. — Journ. de Pharm. March, 1833. 

47. Analysis of Rice. — MM. Darcet and Pateiv have verified by chemical 
analysis the existence in rice of a large amount of azote. This explains the emi- 
nently nutritive nature of that article of food. — Journ. de Cihmie Med. April, 
1833. 



MISCELLANEOUS. 

48. Epidemic Influenza in England. — During nearly the whole of this month, 
(April,) a severe catarrhal epidemic has very generally prevailed in London, 
and many other parts of the country. But few persons have altogether escaped 



268 QUARTERLY PERISCOPE. 

its influence, although in many the symptoms have been so mild as to require 
for their relief and removal little more than the ordinary domestic remedies. In 
those, however, who had sutfered previously from pulmonary complaints, the 
epidemic has in many instances been very severe, and not unfrequently fatal. 
Several cases have fallen under our own care, in which the patients, who had 
before been subject to bronchitis and asthmatic diseases, have been placed in 
danger by the attack of the prevailing malady. In the course of the last fort- 
night we have seen upwards of 150 cases; and, if we are to credit the reports 
we have heard, this is but a small number in comparison with that which has fallen 
to the share of many other practitioners. The disease has usually commenced 
with head-ache and a general feeling of oppression; febrile symptoms of greater 
or less severity, modified of course by the previous state and constitution of the 
patient, has quickly followed; cough, hoarseness, and soreness of the throat, 
with sometimes slight inflammation of the eyes, having either at first attended 
the febrile accession, or speedily succeeded it. In many instances the patient 
has complained of great lassitude, and a feeling of general soreness over the 
whole surface of the body, with pains in the arms and legs. The cough has ge- 
rally been violent and tedious. 

As far as our own observation extends, children have been much less subject 
to the disease than adults, and females much more so than males. 

We are not aware that it has proved fatal in any case where the patient was 
before the attack in good health. We know that many fatal cases have been 
mentioned, but we have found, upon inquiry, that in all these instances the pa- 
tients were invalids at the period of their being attacked with the epidemic, or 
far advanced in age, and likely to fall victims to any disturbance of their feeble 
and worn-out constitutions. 

It has of course been found necessary to vary the treatment according to the 
age and constitution of the patient. With very few exceptions, however, gene- 
ral bleeding has not been required, and, when it has been unnecessarily em- 
ployed, great depression has followed, and but little alleviation of the cough 
and oppression of the chest has been obtained by it. Mild purgatives, saline 
diaphoretics, occasional warm drinks, and confinement to bed for a few days, 
has appeared to be the most effectual and beneficial mode of treatment. An 
opiate at bed-time has generally been given with advantage. The disease is 
now on the decline, but in many persons who have been attacked the harassing 
cough continues, and appears to be but little under the controul of ordinary re- 
medies. 

Many persons, who have imprudently exposed themselves to cold soon after 
the attack, have suffered from severe relapses, the management of which we 
have found much more difficult than the original disease. — London Medical and 
Physical Journal, May, 1833. 

49. Election of a Member of the Academy of Sciences of France to fill the vacancy- 
caused by the death of Baron Portal. — A sort of concours has been held before 
the Academy of Sciences, for the vacancy recently created in that body by the 
death of M. Portal. The candidates, in memoirs, wherein they either gave a sum- 
mary of their previous labours, or discussed some particular points of science, 
each in turn, displayed their claims to the honour, and exhibited their indivi- 
dual capacity. It was Broussais, whose name surrounded by a more brilliant 
halo than that of any other candidate, and who seemed to have less need for 
a repetition of his claims, who brought his competitors into an arena in which 
they had had no expectation of appearing. The contest was sustained with 
good grace by several, but it was evident that this sort of election was not re- 
lished by all. It is in truth much easier to make the most of the weaker side with 
closed doors, than when it is brought forth before an unprejudiced public, 
which does not lend itself to the arrangements of a society, illustrious it is true, 
but exceedingly incompetent to decide upon the merits of a question in medi- 
cine. Hence it was, that the partisans of the candidate who had in truth the 



Miscellaneous. 269 

least right to, but the best prospect of attaining 1 the object desired through in- 
trigue or diplomacy, cried out against the academy for adopting a mode of elec- 
tion altogether unusual. However this may be, after the presentation of the 
two memoirs of M. Broussais, and those of MM. Esquirol and Breschet, M. 
Double, who, it had been announced, was unwilling to submit to this sort of con- 
test, found himself obliged to yield to public opinion. This honorable candi- 
date, being no longer able to decline the controversy, at last presented a me- 
moir, entitled, "The Influence of the Nervous System in the Production and 
development of Disease." After this had been handed in, the committee pre- 
sented the candidates in the following order — MM. Double, Broussais, Breschet. 
Thus we find occupying- the head of the list, the name of the least scientific of 
all the candidates, whilst that of M. Esquirol, to whose labours science is vastly 
indebted, is not even mentioned! Let us hope that the academy in the inves- 
tigation which it is shortly about to make, will show itself more enlightened 
than its committee.* 

We think it our duty to republish the memoir of M. Broussais, read to the 
academy, notwithstanding it has been already published by several journals, in- 
asmuch as the most general and most interesting question in medicine is there 
treated with the peculiar talent, for which the author is so distinguished in the 
investigation of the philosophy of our science. Notwithstanding the errors of 
judgment and of facts, which escape M. Broussais, in consequence of precon- 
ceived theories, there is always in the productions of so clear and vigorous an 
intellect, something to be learned. It is unfortunate that the memoir of M. Dou- 
ble has not received the same degree of publicity; were this the case, we should 
then be better able to appreciate the judgment of the academy. But the jour- 
nal which has been the warmest advocate of this candidate, seems to shun so 
hazardous a disclosure, and has given us nothing more than an imperfect ana- 
lysis of his paper. It is, nevertheless, very easy to perceive, in spite of the eu- 
logies which have been paid rather to the intentions of the author, than to his 
work itself, the paucity of ideas, and the deficiency of principles, which some 
persons at the present day would designate by the epithet expanded, flarges,J 
from inability to characterize them by any other reputable term. We >ghall 
revert again to this subject, upon a proper occasion, and content ourselves 
for the present with referring such as are interested in it, to our report of the 
proceedings of the Academy of Sciences. — Archives Generates, Oct. 1832. 

50. On the Qualifications of a Physician. — The following just remarks on 
this subject are from Tiedemastn's Physiology; we copy them from a late No. 
of the Medico-Chirurgical Review. 

That man is a scientifically informed physician who is well acquainted with, 
and has, as it were, appropriated to his own use, the results of all the inquiries 
made at different times by distinguished observers upon the symptoms, course 
and causes of diseases, and with the precepts of treatment which they have re- 
commended and employed. To become a skilful practitioner, he must under- 
stand how to bring this knowledge into operation, and be ready in applying all 
its rules and deductions to each particular case. This most important talent 
can only be acquired by extensive researches and by diligent study at the bed- 
sides of patients. Cicero has well said, " Nee medici, nee imperatores, nee 
oratores, quamvis artis prsecepta perceperint, quidquam magnae laudis dignum 
sine usu, et exercitatione consequi possunt." The most important attribute in 
the character of a physician, and indeed of every man who is engaged in the 

* The election took place on Monday last, when M. Double was chosen. There are fifty members 
of the academy; the following is the order in which their votes were given. Upon the 1st ballot, M. 
Double received 23 votes, M. Breschet 16, M. Broussais 10, and M. Esquirol 1. Upon the 2d, M. Dou- 
ble obtained 24, M. Breschet 22, M. Broussais 4. Ballot between MM. Double and Breschet. M. Dou- 
ble received 26, and M. Breschet 24. We have been informed that motives in no way connected with 
science caused the rejection of M. Broussais. We should have had nothing to complain of, if the acade- 
my had selected the candidate who stood next to M. Broussais in point of talent, and who of course 
possessed more right to the honour than the one elected. 

No. XXV.— Nov. 1833. 24 



270 QUARTERLY PERISCOPE. 

active and practical employment of life, is, after the acquisition of sound theo- 
retical knowledge, the power or faculty of distinctly and correctly perceiving 
the leading phenomena of the case before him, of tracing the relations of causes 
and their effects, of reasoning upon them, and of applying the deductions to 
the remedial treatment. There are many physicians who are excellent theori- 
sers, but who never become skilful practitioners; for with all their accumulated 
information, they know not how to recognise the individualities of a case, nor 
to reduce the symptoms to any general rule: — such are all merely book-men, 
who have acquired no skill in the sick room. On the other hand, there are 
physicians, and their number is very large, who style themselves sober and 
useful practitioners, and who treat all cases, after the analogy of previous ones, 
and the results of their experience in general, and employ, without being able 
to give any why or wherefore for so doing, certain remedies which they may 
have used on some former occasion with advantage. Such are the sheer empi- 
rics, the routine-men, the despisers of all theory, and the searchers after and 
triers of every new remedy proposed, by those at least of the same school. 
Now, although it may appear at first sight to be the easier method of treating 
diseases upon the analogy of former experience, in reality it is not so; because 
every new case has something specific and individual in its character; and to 
arrive at a successful therapeia, the physician ought to attend to the peculiari- 
ties which result from the differences of age, sex, constitution, mode of life, 
employment, and so forth, and to vary and modify his treatment accordingly. 
This is the business of sound theorising, and if so, then "to practise without 
theorising is, in other words, to practise without reflection." There are seve- 
ral reasons which have led many practical men to reject all theory. — With 
many, the cause exists in themselves; — they are bad reasoners, and in their at- 
tempts to discover and to apply the precepts of sound logic to any case, they 
fall into errors, from the dullness of their perceptions, or from the poverty of 
their thoughts; — they therefore blame the system; and seldom think of their 
own incapacities and deficiencies. With others, the distaste arises from their 
observing the idle dreams and phantasies of enthusiasts, who assume the title 
of theoretical men, style the vagaries of their brains lofty philosophical specu- 
lations, and who have at different times attempted, and not unfrequently too 
have succeeded, in introducing a system of physic into the schools. But as soon 
as physicians have learnt to refuse all credence to mere fanciful notions, spring- 
ing up from darkness, and as soon as they arm themselves with scepticism 
against such nonsense, by weighing it in the balance of sound reason, and re- 
jecting it as the offspring of an unbridled imagination, then shall the vain 
strivings of all enthusiasts become more rare and ineffectual, and a wholesome 
and sound system of theory be no longer despised. 

May the hope which Bacon expressed two centuries ago be soon realized — 
" Speramus et cupimus futurum ut medici nobiliores animos non nihil erigant 
neque toti sint in curarum sordibus." 



( 271 



AMERICAN INTELLIGENCE. 



A Case of Anastomosing Aneurism of the External maxillary Artery, treated 
successfully by Tying the Common Carotid Artery, by David L. Rogers, M. D. 
Lecturer on Surgery. Communicated by S. R. Kirby, M. D. — This case oc- 
curred in a child, aged eight months at the time of the operation. At its birth 
a small pulsating tumour was observed in the centre of the right cheek, which 
continued to enlarge until it embraced nearly the whole of it. 

It was bounded above by the prominent part of the malar bone; below by 
two thirds of the inferior edge of the inferior maxillary bone; posteriorly by 
the superior part of the inner edge of the sterno-cleido mastoid muscle, on a 
range from above downwards with the lobe of the ear; anteriorly, by a line 
drawn from the inferior part of the nostril, and terminating about one inch from 
the symphysis of the chin. The tumour pointed in two places, just above the 
ear, and at the angle of the jaw. It was irregularly convex, having its greater 
convexity at its posterior part, and gradually diminishing from behind forwards; 
its colour purplish, with several red spots on its surface. The child seemed 
otherwise in good health. The operation was performed in the presence of 
Drs. Mott, Baxter and Kirby, on Thursday, December 12th, 1832. An incision 
was made through the skin and the platysma myoid muscle, of about one and 
a half inches in length, in the direction of the inner edge of the sterno-mastoid 
muscle, but nearer to the trachea than to this muscle, which kept the external 
jugular vein at a greater distance; at the first incision a small artery was divided, 
which was secured with a ligature; the adipose tissue was cleared away, and 
very soon the sterno-thyroid muscle was partially exposed, at the outer edge 
of which, the sheath of the vessels was seen, this was punctured, and the artery 
secured with one ligature. No other vessels were tied, and the quantity of 
blood lost did not exceed a wine-glassful. In a short time a diminution of the 
tumour was perceptible. A stitch was made in the middle of the incision, and 
adhesive straps applied. The little sufferer was not much exhausted, it was 
placed in its mother's arms, and immediately began to nurse, with occasional 
restlessness. A gradual diminution of the tumour continued until it had en- 
tirely disappeared, and the child wholly recovered, and is now in good health. 
New York, August 6th, 1833. 

Case of Constipation successfully treated by the Introduction of Air into the 
Bowels. By George J. Janeway, M. D. — July 7th, evening. I was called to see 
H. M., who was attacked last evening with a severe pain in her abdomen, which 
continued the greater part of the night, and was relieved by laudanum and the 
application of a sinapism. She has had occurrences of the pain through the 
day. Two or three days ago, in consequence of imprudent exposure during 
her menstrual period, her menses were suddenly stopped. On the 5th inst. I 
had prescribed for her a bleeding, for an affection of the heart, under which she 
is labouring. She also took a dose of Epsom salt. 

She now complains of severe pain around the navel, which is relieved by 
pressure; pulse full, hard, and frequent, such as is met with in hypertrophy of 
the heart; tongue moist, a little furred in the centre; skin of natural temperature; 
her cellular tissue is infiltrated with serum; abdomen somewhat swollen. Her 
pain was soon relieved by the exhibition of laudanum and ess. of peppermint; 
flannel wrung out in hot brandy and Cayenne pepper. Directed castor oil, 3jj. 



272 QUARTERLY PERISCOPE. 

July 8th. Her pain returned soon after I left her, and has continued. Her 
bowels are more swollen; pain as before; no pain on pressure in any part of 
abdomen; tongue, pulse, and skin as before. V. S. §xvj.; fomentations of 
hops; calomel, grs. xij.; oil four hours after. Her bowels have not been opened 
since the 6th. 

6 P. 31. Bowels not open; vomiting- occasionally; abdomen more tympanitic; 
pains more severe; respiration hurried and somewhat oppressed. Soda water; 
repeat calomel; injections of senna tea. 

10th. Since the preceding date, all the symptoms have gone on increasing in 
severity, for which I directed at different visits, leeches and cups to abdomen, 
cups to small of back, injections of warm and cold water, emollient injections, 
calomel and senna tea, fomentations to abdomen, &c. all without success. Bowels 
are still confined, greatly distended with gas; pulse pretty much as before; 
tongue furred in centre and moist; skin nearly natural; breath excessively fetid, 
can be smelt at the distance of several feet; belches considerably; hiccup occa- 
sionally; vomits a dark, fetid, oily fluid; respiration frequent and oppressed; face 
pinched. 

At this time I determined to try the effects of the introduction of air into the 
bowels. Accordingly I attached one end of a bladder to the tube of a bellows, 
while a glyster pipe attached to the other end was introduced into the rectum. 
The bellows were used a few minutes, during their use a fetid gas escaped 
from the rectum, in such quantity as to be smelt in different parts of the room. 
Immediately after the removal of the bellows, the patient passed by stool a pint 
of very fetid, dark fluid, together with a considerable quantity of gas. She felt 
somewhat relieved. A short time after, the bellows were reapplied with simi- 
lar effects. A drop of croton oil was then given, and another at the expiration 
of two hours; the bellows were used twice afterwards. 

Evening. Patient is much relieved; has had six passages by stool since the 
morning, she passed at the same time great quantities of gas. From this time 
she speedily recovered from her bowel affections. Her stools did not become 
of a natural appearance till some days after. 

New York, August 1, 1833. 

Case of Prolapsus Uteri from JDysmenorrhcea, together with the Formation and 
Expulsion of an Organized substance. By John W. Malone, M. D. of Quincy, 
Middle Florida. — On the 30th September, 1831, 1 was called to see a lady, who 
was said to be suffering very much from a prolapsus of the womb. Upon my 
arrival, she informed me, that her menstruation had been very scanty and pain- 
ful for a day or two previous, and that last night her symptoms were very much, 
aggravated — in fact, to use her own language, she said " her body came down," 
meaning by that a prolapsus uteri. She complained of great pain in her back 
and lumbar region in general, and also at the pubis and in the groins, darting 
sometimes upwards to her left side; there were bearing-down pains, and a sen- 
sation as if something were protruding per vaginam, great difficulty and con- 
stant desire to void urine, which came away by drops only, her sufferings were 
much increased whenever she was raised in bed or stood erect, she was quite 
nervous, and her bowels were obstinately constipated. The pulse was perfect- 
ly natural, no gastric derangement except once and a while she was troubled 
with flatulence. 

I gave her an anodyne draught as a palliative until I could investigate her 
situation further — this gave her but temporary relief, and in the course of an 
hour or two I proceeded to an examination, and found the uterus prolapsed as 
anticipated. Not having a pessary at hand, I gave her ol. ricini.; ordered cold 
applications, together with spts. nitre and laudanum at bed-time, and enjoined 
perfect rest with the hips elevated, in order to keep the uterus as much as pos- 
sible in situ. 

31st. Had spent the night rather less unpleasantly than the preceding, but 
still she was in great distress. The difficulty in urinating was more obstinate. 



American Intelligence. 273 

amounting almost to a total suppression. Upon the introduction of the catheter, 
a large quantity of turbid urine flowed off. The menses appeared during the 
night for a little while. The darting of the pain from her groin up to her left 
side was more constant, no evacuation from her bowels had been effected by 
the oil. I immediately ordered an injection, and after its operation introduced 
a sponge pessary, and enjoined it upon her to remain in the recumbent posture; 
she felt much easier, and dropped off into a short but refreshing slumber: to- 
wards evening the pain again returned, and became so intolerable that the pes- 
sary was removed. Astringent injections were then freely thrown up the 
vagina, and an anodyne draught of camphor and laudanum was given at bed- 
time. 

October 1st. Found my patient sitting up in bed, had slept well during the 
night, but this morning had slight pains, which were attended with the expul- 
sion of a thin membrane of a pearl colour; feels now entirely free of pain, and 
has no difficulty in voiding her urine, &c. Still continue vaginal injections, 
remain quietly in bed, and keep the bowels open with senna and the neutral 
salts. Two days afterwards I visited her, and found her still improving, though 
she complained of weakness and sluggishness of the bowels: ordered a plain 
and nutritive diet, mild laxatives and gentle exercise, together with a prepara- 
tion of iron and myrrh, as there appeared to be a want of tone in the whole 
system, and the uterine in particular. 

She continued this course for more than a month, and the last time I saw her 
she was enjoying very good health, and had not had a return of "prolapsus" 
since. 

The only inducement to publish this case, is the circumstance of its being the 
consequence of " painful menstruation," which to me is self-evident, as she 
never was similarly affected before; and from the sudden production of it; upon 
the occurrence of the painful efforts common to this disease; and from the 
prompt effect of the astringent injections, it clearly manifests a want of tone 
in the uterine fibre, and a relaxation of the parts, that readily yielded to the 
bearing-down pains of this distressing affection. 

Hot Springs of Virginia. — A correspondent has favoured us with a detailed 
account of the medicinal value of these thermal waters in three cases of very 
obstinate disease, of which we have thought proper to make a digest. In the 
group of mineral waters commonly known under the appellation of the Virgi- 
nia Springs, and which are scattered in the southwest part of the State, over an 
area of forty-five miles diameter, there is a small cluster called the Hot Springs, 
the temperature of which ranges from 99° to 108°. The popular belief is, 
that they are extremely useful in rheumatic and many other affections, when 
used as a bath, or by submitting the diseased region to the stream of the spring 
whose temperature is 108°. This establishment has recently passed into the 
hands of a highly enterprizing and intelligent proprietor, Dr. Goode, who by 
accommodations actually existing and by such as are in progress, promises to 
make this a retreat well worthy of the invalid, or the man of leisure who 
wishes to spend a short time from home. 

The first patient, Mr. Corrie, of Charleston, S. C, aged 18 years, was afflicted 
in 1832 with a rheumatic affection, which rendered him as helpless as an infant; 
he was unable either to dress or undress himself, and whenever he changed his 
place, he was under the necessity of being carried. Having reached the White 
Sulphur Springs on the 28th day of June, he remained there until the 9th of 
July, drinking daily eight or ten glasses of the water, by which he was suffi- 
ciently improved to walk with the aid of crutches, three or four days before he 
left there. He then went to the Hot Springs, distant thirty-five miles. 

At the latter place he took on alternate days the hot stream as a douche, and 
the sweating bath until Sept. 2d. In two weeks after he instituted this process 
he laid aside his crutches, and resumed the unaided use of his limbs, and at the 

24* 



274 QUARTERLY PERISCOPE. 

expiration of the whole period, he was so fully convalescent, that being caught 
in a storm at sea on his return home, he assisted in the securing of the vessel. 

The second patient, Mr. Lockwood, from his own account, seems to have had 
an extensive dartrous affection which for ten years had defied the best medical 
counsel of Charleston, S. C. The incipient eruption was in small specks, co- 
vered with a scale, and which increased in size until they joined. The whole 
body was subject to this affection; the eyebrows, lips, and nostrils, without in- 
termission — the other parts of the face and hands not so much so. The itching 
was so extreme as to produce almost derangement; the scales rubbed off at 
night under this excitement would fill a small saucer, and the night-dress was 
stiffened with the discharge of blood. The scales were renewed every twelve 
hours. The only application which afforded any comfort was the white of a 
fresh egg rubbed up with a tea-spoonful of sweet oil or fresh cream, any ran- 
cidness in the latter produced an irritation like a fire-brand. 

This patient is now on his third annual excursion to the springs, having in 
each instance used the White Sulphur water for ten days in the outset, and 
then gone to the Hot Springs, where he has resorted on alternate days to the 
spout of warm water and to the sweating bath. He has now not a vestige of 
the complaint, and there is no indication of a return of it, (Aug. 7, 1833.) 

We have also the account of another case of rheumatism, in the person of 
Mr. Booker Preston, of Bedford, Va., which began in 1827, and which seems 
to have been of a very severe and enduring character. It was, however, also 
relieved entirely by the use of the pool called the boiler, at the Hot Springs. 

W. E. H, 

Description of a Safety Stirrup. By Samuel Jacksobt, M. D. of Northumber* 
land, Penn. [Communicated in a letter to the Editor.]-— The business of the 
practical physician is not merely to prevent or cure diseases, but also to obviate 
all the casualties to which we are liable in the journey of life; hence, though 
the present paper may not be quite medical, or pertain, very strictly consider- 
ed, to the pages of your journal, yet inasmuch as it recommends the means of 
safety to your numerous readers, most of whom are country practitioners and 
riders on horseback, it will not, by them at least, be thought out of place. 
Were I to present them with an effectual preventive or cure of hydrophobia, 
how great would be their exultation; and yet what we are now recommending 
might have prevented more death and distress, in this neighbourhood at least, 
than has ever resulted from rabies canina. Not one case of this disease has been 
known within a radius of fifty miles from this place, and probably not within a 
much greater distance, for the last half century, while, within this very vici- 
nity, and within a very few years, the most distressing lacerations and even 
death have been the sad consequences of persons being dragged by the 
stirrup. 

It is generally supposed that the spring stirrup, which opens at the side, af- 
fords safety in these cases, and there is an extract from one of my letters in the 
Medical Recorder, Vol. XL p. 203, in which it is highly recommended as secur- 
ing the exit of the foot, let the rider fall in whatever way it is possible. But we 
have since learned from the actual experiment of falling and hanging by the 
stirrip in propria persona, that our opinion, so confidently advanced, is utterly 
erroneous. 

After using the stirrup for many years with the most comfortable assurances 
of safety, I was at last thrown, and my foot was held fast by it, while my head 
and shoulders rested on the ground. In this dreadful situation, my horse, though, 
young and high-spirited, stood quiet by my side, while with infinite labour and 
pain, I extricated my foot. I was then told that the rust of the hinge was the 
cause of its refusing to open, but this was a great error, as was proven by the 
following decisive experiment. 

The hinge was well greased, and made to work with very slight force; I then 
extended myself on the carpet with my foot in the stirrup, and giving- the 



American Intelligence. 



275 



leather to my servant, I found it absolutely impossible to open it with my foot. 
The operations were varied in every way in which it was thought possible for 
a man to fall from his horse, and with the same result. The foot turns quickly 
round in falling, and hangs by the foot-piece of the stirrup. 

I mentioned these things to my talented friend, Mr. Henry W. Snyder, of 
Selinsgrove, son of the late Governor of Pennsylvania, and he quickly made 
me a pattern of a stirrup, which I have since procured to be made by George 
Taber, of Philadelphia. It can be easily understood from the plate. Fig. 1, 
the entire stirrup. Fig. 2, a side view. Fig. 3, the foot piece. 




For an adult, three of the upright or safety irons are sufficient, but as the 
stirrip may be used by very young persons with small feet, they ought to be 
very close, and five would be required. These safety bars may be an inch 
broad. In order to afford him foot-hold, the foot piece ought to be broad, and 
the opening in it guarded by a bar in the transverse diameter, as seen in the 
plate. 

We cannot recommend this as a very handsome part of a horseman's capari- 
son, but it is certainly not very unsightly; and until something better be in- 
vented, we beg leave to obtrude it upon the attention of all who would ride 
without fear of the deplorable consequences of being dragged by the common 
stirrup. Nearly all the evils attendant on human life are the immediate or re- 
mote consequences of neglecting either the moral or physical laws, by which 
our safety is ensured; and if any one reads this paper without availing himself 
of this cheap and easily procurable prophylactic, let us refer him for further 
instruction to one of the best books that ever saw the light — Combe " on the 
Constitution of Man." "We ought," says this author, " to trace the evil back to 
its cause, which will uniformly resolve itself into infringement of a natural or 
moral law; and then endeavour to discover whether this infringement could or 
could not have been prevented, by a due exercise of the physical and mental 
powers bestowed by the Creator on man." 

Case of Incongruous Twining, ( Nosology, Good. J ♦ By Thomas J. Charltost, 
M. D. of Bryan County, Georgia. — I was called to visit a woman belonging to 
Mr. Clay of this county, who was said to be nearly nine months advanced in 
her third pregnancy, and to be suffering under a sudden affection of the womb,, 
which her attendants supposed to be a prolapsus. On examination I found the 
lower extremities of a foetus in the vagina, it was extracted with no difficulty 
and with the slightest exertion. Upon making a section of the umbilical cord 
no blood issued, nor had there been any discharged from the uterus before I 
saw her, neither had she had the slightest pain; the symptoms which alarmed 



276 QUARTERLY PERISCOPE. 

her and occasioned my being called, was a sensation of faintness which I attri- 
bute to apprehension of danger excited by the nurse. The foetus was not putrid, 
but had evidently been dead some weeks; it was apparently one of the seventh 
month, and was in appearance and to the smell as if it had been preserved in 
pyroligneous acid; the viscera were much diminished in size, and externally it 
consisted merely of the integuments closely applied to the bones. As there was 
neither pain or flooding, I did not deem it proper to introduce the finger into 
the womb, fearing that the premature expulsion of another child, the motion 
of which I plainly felt on the application of my hand externally, might be caused 
by such interference. I directed her to be kept quiet, and that I should be 
immediately summoned should any of the precursors of labour occur. For 
eight days she was without any symptoms, on the night of the ninth labour 
came on, and the delivery of a child healthy and of the full time took place be- 
fore I could see her. On examination of the placenta I found the cord of the 
former birth attached to the side, and that of the latter to the centre. 

I am aware that many cases have been mentioned by writers of twins born at 
remote periods from each other, but what I thought remarkable, and which has 
led to the report of the above case, was, the absence of pain, and to all appear- 
ance of contraction in the expulsion of the dead foetus. The uterus has been 
said to be "a life within a life," and the occurrence here mentioned would 
give some confirmation to its supposed powers of independent resolve, as well 
as action; for the casting off of the dead foetus without the usual means of pain 
and contraction, would imply in some degree a consciousness that such means 
were not fitted for the present case, as tending prematurely to expell its re- 
maining contents. Or to speak more accurately, I may say, that the above cir- 
cumstances are additional evidences that all the organs, and most especially the 
uterine system, have the faculty of adapting themselves to contingencies and 
abnormal occurrences. 

On the Pathology of Cholera. By Charles A. Lee, of New York. [Extracted 
from a letter to the Editor.] — I found at a very early period, that the pathology 
of cholera was likely to be a subject of warm dispute among our physicians, as 
it has been in Europe and Asia, and I endeavoured to keep my own mind per- 
fectly unprejudiced, while observing and investigating the nature of the dis- 
ease, that I might arrive at correct conclusions. Being fortunately placed in 
the most favourable circumstances to observe the disease, and pursue post mor- 
tem examinations, I endeavoured to improve them to the best advantage; and 
the numerous facts which I have collected go to confirm me in the opinion that 
the phenomena of cholera can only be satisfactorily explained, by the existence 
of an intense irritation of the gastro-intestinal mucous membrane. It was a fact 
very generally observed during the epidemic, that, hypercatharsis was often 
caused by laxative and purgative medicines in ordinary doses, and all who had 
opportunity of treating the disease to any extent, acknowledged the danger of 
administering such articles, For the same reason, crude vegetables and other 
indigestible food, (which acts as foreign substances,) were proscribed, and the 
most bland diet recommended. Within my own knowledge, instances were 
frequent where an attack of cholera was brought on by a cathartic, of which 
I will relate a few as examples. 

Miss R., a young lady of respectability, on returning from the city towards the 
close of the epidemic, took a dose of bilious pills, on going to bed, and was 
attacked with violent diarrhoea in the night. In the morning early, she was in a 
collapsed state. Previously to taking the pills, she was in perfect health. She 
died. Mr. and Mrs. L., by the advice of a neighbour, took a large dose of ep- 
som salts for two mornings in succession; hypercatharsis followed. They were 
removed to the hospital, where both died. J. C. complaining of slight nausea, 
took, by the advice of a physician, an emetic of tart, antimony; a violent attack 
of cholera succeeded, from which he with difficulty recovered. J. H. was ad- 
vised, by way of precaution, to take a dose of physic. He took calomel and 



•American Intelligence. 211 

jalap, aa. gr. x. ; a violent diarrhoea succeeded, and terminated in collapse. Nu- 
merous other cases of a similar kind could be given, but it is unnecessary. So 
generally acknowledged is the existence of this morbid irritability of the gastro- 
intestinal mucous membrane in this disease, that all prophylactic measures, both 
dietetical and medicinal, appear to be based upon it. 

Another fact which early led me to the belief of an exalted action of the se- 
cretory vessels of the mucous tissue, is the analogy existing between the symp- 
toms of cholera and those caused by the acrid poisons. Of several cases which 
I might relate, I can give at present but the two following. In January, 1828, 
I was called to see a delicate woman who had taken an overdose of tart. ant. 
I found her with features shrivelled, a livid areola about the eyes, which were 
sunken, voice a whisper, pulse imperceptible, great jactitation, vomiting and 
purging a colourless fluid without smell, cold sweat over the whole surface, and 
violent cramps in the muscles of the extremities. In July, 1832, I was called 
from the cholera hospital to visit a young woman who had swallowed, a few 
hours previously, half an ounce of arsenic. On seeing her, had I not known 
the cause of her attack, I should have had her immediately removed to the hos- 
pital, as a well-marked cholera case, as she had all the symptoms of a patient 
in the collapsed stage. Here then are two cases of intense concentration of in- 
nervation upon the mucous membrane of the stomach and intestinal canal, from 
the action of well-known irritants, and the symptoms were those of cholera. Is 
it possible that a directly opposite condition of the same membrane, would give 
rise to the same phenomena? 

The opponents of this pathology of cholera appear to me to level all their 
arguments against a phantom of their own creation. They stoutly deny the ex- 
istence of Inflammation, which few or none contend for, while they frequently 
concede, which is all we ask, the existence of a high grade of irritation. If 
life be sufficiently protracted after an attack of malignant cholera, the 
latter may, and generally does terminate in the former; but that any pathologist 
should seriously look for the traces of inflammation in a disease of six or twelve 
hours standing, is very strange. Post mortem appearances sustain most une- 
quivocally the doctrine of irritation, so far as its pathology is understood; for it 
should be borne in mind that in cases of sudden death from large doses of ar- 
senic, colorations and other marks denoting inflammation, have been entirely 
wanting. 

New York, Sept. 4th, 1833. 

Case of Cancerous breast, with Partial Ossification of that Organ. By John 

Maclellan, M. D. of Green Castle. — Mrs. H , aged fifty-eight years, had a 

cancerous breast, which I extirpated on the 18th of July, 1831, assisted by Drs. 
M'Gouvrin and Green. It was of enormous size, and had been enlarging for 
twelve years, and weighed thirteen pounds. It was ulcerated on the surface 
in two spots, and there were collections of cancerous matter in several places 
throughout its substance. What was very remarkable, however, in this case 
was the existence of bony deposits in the centre of the breast of several inches 
extent in different directions. I have some of this part of the breast preserved 
in alcohol, in which the bone is very manifest. The artery next the sternum 
was very much enlarged, and bled profusely when cut. The other arteries 
were as usual. The glands in the axilla were not enlarged. The wound heal- 
ed in a great measure by the first intention. We saved skin enough to cover 
it, and brought it well together by ligatures and straps of adhesive plaster. The 
breast was painful for a considerable time before it was taken off, and the weight 
of it was oppressive. It extended down to her waist, and in walking she sup- 
ported it with her hands. This woman never had any children, though married 
when young, and her other breast was small and not pendulous. 

Casein which a Stiletto Remained for Twelve Years Projecting into the Brain.— 
In the pathological collections belonging to the Hospital Santa Maria Nuova, at 



278 QUARTERLY PERISCOPE. 

Florence, there is a portion of a parietal bone in which the point of a stiletto is 
projecting 1 through the inner table nearly an inch. This was found so at the 
patient's death. The scalp had healed over it, and the injury occurred twelve 
years before the patient's death. — Med. Magazine, Sept. 1833. 

Cases of Periodical Diseases treated with Ergot, in Mississippi, 1825. By Henry 
Perrine, M. D. — Case I. Joe, a negro, taken with a chill and fever, Tues- 
day, 5th July, 10 A. M. which lasted till the middle of the afternoon. A dose 
of calomel given during the hot stage acted as emetic and cathartic; discharges 
copious, but not much vitiated; sleepy at night. 

Wednesday.— -Took a large table-spoonful of Peruvian bark this morning; 
chill and fever worse to-day; tongue still nearly clean. Night. — A dose of ca- 
lomel and opium at bed-time; halfa pint of strong infusion of quassia to be taken 
in half-gill doses every two hours while awake. 

Thursday morning. — Calomel has not operated as a cathartic. R. 5J- pow- 
dered ergot to be taken before chill time. Afternoon. — No chill, no fever, no 
catharsis during the day; lips are breaking out; gums becoming sore. R. A 
dose of salts, which at night operated well. Two worms were passed. 
Friday. — Says he is well except weakness. 
25th July.— SUM well. 
January 1st, 1826. Has not relapsed. 

Case II. John, a mulatto. Saturday, 9th July, afternoon. — Slight chill and fever. 
Monday forenoon. — Severe and long chill and fever. Took the emetico-ca- 
thartic of salts and tart. ant. during hot stage, followed by Epsom salt and mag- 
nesia in the afternoon, and calomel at night. 

Wednesday 18lh. — Took three doses of ergot, each fifteen grains, in two 
hours previous to the chill, which came on between 9 and 10 A. M. and the fe- 
ver lasted till in the afternoon. 

Friday 15th. — Has taken this forenoon, in four doses, seventy-five grains 
of ergot, which induced no sickness, and have not been followed by either chill 
or fever. 

Monday, 25th. — Continues perfectly well. 
January 1st, 1826. — Has had no relapse. 

Case III. Lucy, a negress, was sick at the same time with Joe, but was cured 
by bleeding, purgatives, and bark. After spinning several days, a head-ache 
came on in the afternoon of each day, which was soon accompanied by a slight 
fever, not relieved by continued purgatives. 

21st July. — Took fifteen grains of ergot four hours previous to the expected 
paroxysm, which puked her in half an hour; and the next equal dose having 
the same effect, I gave her, at forty minutes apart, three doses of ten grains 
each, with a little pepper. Neither puked her, nor has her fever or head-ache 
returned to-day. 

25th. — Has taken nightly laxatives — head-ache has not returned. 
January 1st, 1826. — No relapse. 

Case IV. Leah, a mulatto woman, twenty -five to thirty years old, mother of 
four children. Last summer delivered of twins at seven months, both dead. 
Has had but four or five menstrual discharges since; in all coagula with pain at 
"the bottom of the belly." A few weeks since was attacked with periodical 
head-ache, for which she was depleted very profusely, and repeatedly by vene- 
section, emelics, and purgatives, without entire relief. Has had for a few days 
past an evening recurrence of the same head-ache. Says that she has been sub- 
ject to it every summer as long as she remembers since womanhood. 

25th July. — Yesterday catamenia came on. To-day very painful, with expul- 
sion of coagula. To-night feels tumid in the hypogastric region — has taken 
two doses of camphor without affecting the pain in her head. R. Four fifteen- 
grain doses of ergot at intervals often minutes each. After second dose, com- 
plained of increased uterine pain for a minute, at intervals of five minutes, but 
says her head-ache is principally gone. 



American Intelligence. 219 

26th. — Waked this morning" by severe uterine pain, which was relieved by- 
local heat. Menses did not flow during- the night, but to-day are natural in 
quantity and quality. Drank horehound tea through the day. 

September, 21st.— Has continued free from head-ache. 

January 1st, 1826. — No relapse. 

Remarks. —The male cases may be questioned. The female cases were evi- 
dently cured by the ergot alone, I shall experiment with the ergot again un- 
der similar circumstances. 

Campeche, September 10th, 1833. 

Note on the supposed efficacy of Peruvian Bark as an Antidote to Arsenic. By 
Henry Perrine, M. D. — I perceive under the head of American Intelligence, 
in the May No. of your Journal, a ' note' to yourself " On the Peruvian Bark as 
a counter-agent to the Poisonous Effects of Arsenic," which was elicited by the 
outlines of my own case in your number for November last. The note itself 
simply contains the report of an unknown third person's having- successfully 
treated several cases of poisoning by arsenic, with large doses of Peruvian bark 
and milk, without stating* whether they were followed by vomiting, and thinks 
it therefore worthy of inquiry how far the action of the poison may have been 
checked by the Peruvian bark in my case. Hence, in this note to yourself, I 
say, that in my opinion the powdered Peruvian bark had in my stomach about 
the same effect as an equal quantity of pine saw-dust, chesnut charcoal-powder, 
ground Indian corn, or any other comminuted matter with which the undis- 
solved arsenic would as readily mix, to which it would as firmly adhere, and 
with which it should as soon be carried out of the stomach by vomiting. As 
milk by coagulating in the stomach is infinitely preferable for these purposes, 
I drank it abundantly, but hurried out the coagula, and their enveloped ar- 
senic, as soon as formed, with mucilaginous drinks and blue vitriol — of which 
seven doses were taken in rapid succession. Having no faith in antidotes, as 
soon as the vomited fluids exhibited no traces of arsenic, I tried to make the 
remaining poison travel through my intestines as fast as possible; and as calo- 
mel in pills was the only purgative which my stomach would retain, I continued 
it aided by numerous glysters, until the discharges from the bowels no longer 
turned green with a solution of the sulphate of copper, which occurred on the 
morning of the fourth day. I should nevertheless have probably died, had not 
the magnanimous mercury, at the most critical period, pervaded my system and 
equalized its circulation? nor was that the only dangerous epoch in which I 
have owed to this noble medicine the continuance of my feeble existence. 
Consulate U. S. A. t Campeche, September 10th, 1833. 

St. Augustine, East Florida, as a Resort for Invalids. — The Twelfth No . of our es- 
teemed cotemporary, the Medical Magazine, contains an interesting communica- 
tion from Dr. L. V. Bell, in which the statements hitherto made of the propitious- 
ness of the climate of St. Augustine to persons labouring under pulmonary affec- 
tions are directly controverted. " St. Augustine," observes Dr. Bell, "like all the 
settlements on our southern frontier, has been the occasional place of resort for 
northern invalids from time immemorial, but it is only since the change of flag 
in 1821, that any considerable numbers have visited it, and only within the last 
four or five years that much attention has been directed to it, as possessing any 
peculiar advantages over the southern states generally. This late notoriety is justly 
and almost entirely ascribable to the efforts which have been made to attract pub- 
lic attention and create an artificial reputation for the place, by the publication 
of such statements and circulars as have been alluded to, which have been very 
extensively circulated throughout the New England and middle states. In fact, 
of about one hundred invalids who were there in the winter of 1830-1, I had 
from personal acquaintance, reason to know that more than three-quarters were 
immediately induced to give it the preference from the influence of these ac- 
counts. 



2S0 QUARTERLY PERISCOPE. 

" In the present communication the writer regTets that many of the state» 
ments heretofore made to the public must be directly controverted. He would 
however premise that he does not intend to call in question the veracity of those 
who have given different views, many of which he is aware were predicated on 
supposed authentic data, the real errors of which will be pointed out, while 
other flattering" conclusions were drawn and published after so very limited re- 
sidence and research, that subsequent more extended opportunities must have 
shown the writers how much they were themselves deceived, and how much in 
turn they had misled the public* I can pretend to offer, as respects the cli- 
mate, only the results of personal experience during" one season, and that no 
doubt one of rather unusual severity, but I took every caution scrupuously to 
avoid all error in my own observations as well as to corroborate every statement 
heard, as to the inclemency of former winters, by inquiries among unprejudiced 
and uninterested citizens who had been residents for a greater or less period of 
time. 

" The city of St. Augustine, (it being a corporate municipal body,) is situated 
in latitude 29° 51/ N. on the eastern shore of the cape or peninsula of Florida, 
and on a bay formed by the junction of three short tide rivers, the Matanzas, 
St. Sebastien's, and the North. It is at the distance of about two miles within 
the bar, which stretches from the main land to Anastasia Island. This bar ren- 
ders the entrance or exit of vessels drawing more than 9 or 9£ feet of water im- 
practicable, and is said to be constantly changing its direction, leaving a very 
circuitous channel much influenced in its depth and direction by the tides and 
winds. The attempt is rarely made to enter without a pilot; and from the na- 
tural obstructions, as well as the want of capacity, indolence or absence of com- 
petition among the pilots, the harbour is justly esteemed one of extreme diffi- 
culty. It is no unusual circumstance for vessels to be detained at the bar for 
weeks, (a most tantalizing situation for the sea-worn invalid,) and they have oc- 
casionally returned or changed their destination, having waited in vain for the 
pilots. 

** The surf breaking on the outside of Anastasia Island in certain winds is tre- 
mendous; when heard in the city it resembles very much the roar of Niagara 
Falls, a circumstance not a little annoying to the sick before the ear becomes 
accustomed to the sound. 

" The city, which is surrounded by a small creek called the Mari Sanchez, 
swollen however into a considerable stream at high water, consists of four or 
five streets, from sixteen to twenty feet only in width, running nearly parallel 
to the Matanzas, about half a mile in length, and intersected every few hundred 
yards by others crossing at right angles. A considerable open space is left near 
the middle of the city which is dignified with the appellation of Plaza de la Con- 
stitution, in the centre of which is a monument of plastered shell rock, built in 
commemoration of the constitution granted to Spain by her monarch. Around 
this square the three or four churches, and public buildings are situated. The 
streets are in general built upon pretty compactly, but a great number of the ha- 
bitations are in a deserted and completely dilapidated condition. The exterior 
of the buildings is of a most unpromising description, resembling at a general 
view an irregular conglomeration of roughly plastered hovels; and in fact, the 
entire aspect of the place is that, which is actually its case, of * having seen 
better days.' There are, however, some half dozen of the residences, which 
are tolerably convenient and comfortable. The dwelling-houses generally bear 

* " The late Dr. James Cox, who left Philadelphia, and settled in practice at St. Augustine, the cli- 
mate of which he, it would seem, vainly supposed, had cured him of a chronic bronchitis under which 
he laboured, and whose circular giving an overrated account of the prospects of that place in pulmo- 
nary maladies, (though his statements were far from being so exaggerated as those of some others,) 
were widely spread in the Journal of Health, N. A. Med. and Surg. Journal, &c. had the magnanimity 
to declare that, had he known as much of the climate of Florida at the time of publishing his circular, as 
he subsequently learned, nothing could have induced him to advise an invalid to seek such a situation. 
He also expressed to me his intention of informing the public of the errors in his first statements and 
opinions. Whether or not the community were ever disabused in relation to this subject in the same 
channels in which the accounts were first published, I have not learned. 



American Intelligence. 281 



"O 



some marks of the Spanish taste, as in having the entrance through a high court- 
yard, balconies projecting over the street, &c. There is, however, too little 
uniformity in external appearance or internal construction to allow their being 
referred to any one model. The floors of many of them are constructed of 
tabbia, a mixture of lime and shells, which becomes in time much consoli- 
dated and smooth, but in winter is cold, damp, and uncomfortable. The 
material of which almost all the houses are constructed, is a conglomerated 
shell rock, which is found abundantly on Anastasia Island, within a few miles. 
"When first removed from the quarry, its structure is so soft as to allow of its 
being prepared for building by being hewn with the broad-axe, but it attains a 
considerable degree of solidity after long exposure to the atmosphere. 

"This is the only kind of rock found in this section of Florida. The whole 
surrounding country is a perfect level of sand, intermingled with broken 
pieces of shells, and destitute of every mineral production, even the smallest 
sized stone. No natural elevations, even of a few feet, are to be found. 

" The agricultural productions of the vicinity are almost nothing. A little 
market-place is furnished with one beef, uniformly of miserable quality, which 
is adequate to the consumption of the whole place, with fish of some variety, 
including a small and indifferent species of oysters, and rarely with pork and 
poultry. Mutton is never seen; sheep, it is said, being immediately destroyed 
when turned to pasture, by a small sharp-pointed bur called the cockspur 
which grows every where. Garden vegetables of all kinds, as well as hay, 
butter, apples, &c. must be brought from the north, and are generally of indif- 
ferent quality and high prices. The market is so limited and the number of 
vessels arriving so small, that there are frequently long periods in which some 
of the most necessary and essential articles cannot be obtained at all, or only at 
the most exorbitant rates; butter for example, at seventy-five cents per pound. 
With a soil and climate capable of producing almost every article of vegetable 
use or luxury, such is the indolence and want of enterprise of the great bulk 
of the population, that they prefer subsisting day after day on fish, oysters, and 
the sweet-potatoe, to the trouble and labour of raising breadstuffs, garden ve- 
getables, poultry, &c. 

" The only article of export, and what with the exception of invalids forms the 
only article of traffic of the population, is the crop of oranges; of these one 
hundred and twenty thousand are raised in an average year, worth ten dollars 
per thousand on the spot, and there is always a very ready demand for them. 
But strange as it may seem, where the land is cheap, the growth of the trees 
quick and easy, seven or eight years from the seed being enough to render them 
profitably productive, the quantity raised per annum increases very slowly, al- 
most no new plants being set out. 

" The population of St. Augustine, by the return of the marshal at the census 
of 1830, was as follows: — 

White males 570 Slaves 474 "^ 

White females 538 Free blacks 126 I Tota ] if OS 

Whites, 1108 Coloured, 600 j 

An amount very much below the statement of any gazetteer or account which 
I have seen. Of this population, a great proportion of the whites, probably not 
less than seven to eight hundred, are minorcans, as they are called. They are 
descendants of a colony of redemptioners, brought out from the Balearic islands, 
in 1785, by one Turnball, an Englishman, to New Smyrna, or Musquito Inlet, 
about sixty miles south of St. Augustine. From fear of being permanently re- 
tained as slaves, and finding him unable to fulfil his contract for their support, 
they abandoned him in a body and came to St. Augustine, where they have 
since lived almost unmixed with the Americans, retaining all their original ig- 
norance, indolence, and superstition. They speak a kind of patois, between the 
No. XXV.— Nov. 1833. 25 



282 QUARTERLY PERISCOPE. 

Spanish and Italian, and are without exception Catholics with the feelings and 
views of a century or two gone by. From what has been said it will be readily in- 
ferred, that almost all those articles which are so comfortable and almost essen- 
tial in sickness, are to be had only from a great distance, or what happens con- 
tinually in so small a market, not to be obtained at all. Milk, usually considered 
so important an article of diet in consumptive cases, was not to be procured ex- 
cept with much difficulty, and in very small quantities; so much so, that proba- 
bly no invalid there attempted to make it an exclusive, or principal article of 
food. In fact, the sick are constrained to do without those thousand articles of 
caprice or utility, which at the north are ever ready to soothe the fancy, or al- 
leviate bodily distress. 

" The privileges of taking exercise at St. Augustine are few and inconvenient. 
After leaving the immediate bounds of the city, there is nothing to interest or 
amuse the mind. A perpetual succession of scrubby woods and barren sands, 
without one pleasant landscape or agreeable view, presents few inducements to 
prompt the invalid to embrace that valuable auxiliary in chronic disease, exer- 
cise in the open air. The means of gestation are few and very expensive. 
Horses are almost unknown, their place being very imperfectly filled by a breed 
of Indian ponies about the size of the common jackass. Carriages of every de- 
scription are hardly to be obtained, nor any kind of boat, the rowing and sailing 
which is often an agreeable and salutary mode of exercise, except the misera- 
ble, inconvenient, unsafe dugout or log canoe. 

"In short, (excepting the climate, whose claims to attention we shall shortly 
examine,) St. Augustine possesses in a most eminent degree the deficiency of 
every thing which can amuse, improve, or restore the invalid, and the presence 
of every thing which can serve to irritate his feelings, impoverish his estate, and 
disappoint his hopes. 

" I have gone considerably into these statistical particulars respecting this 
place, being induced by the fact that all our gazetteers give very erroneous ac- 
counts of it, several of them stating its population to be from four to five thou- 
sand, one placing it at the foot of a considerable hill, &c. ; and still more from 
the circumstance that the circulars addressed to invalids, for obvious reasons, 
attempt to keep up the impression that it is a large flourishing city. 

" The statements respecting the climate of this part of Florida, which have 
been repeated in all the various accounts, have had as a pretended basis actual 
thermometrical data. But it may be, that even these which at first sight appear 
incapable of misleading, agreeable to the old axiom that ' figures cannot lie,' 
are in fact easily distorted, so as to convey very erroneous impressions as to 
the value and expediency of the situation for the valetudinarian. The error 
which has most prominently affected these statements, has arisen from the un- 
fair, injudicous exposure of the instrument from which the observations were 
made. The published memoranda have been those abstracted from the jour- 
nal kept by a military regulation of the government at the barracks. The ther- 
mometer, apparently an ordinary, cheap, American instrument, is suspended in 
the second story of an immense stone building, at the side of a door which forms 
a communication between two large rooms, each of which has two open win- 
dows on the S. E. and N. W. sides. The whole storj*- is surrounded by a roofed 
piazza, twenty or twenty-five feet in width, so that in fact, the thermometer is 
not within some forty or fifty feet of the open air. A moment's reflection will 
convince any one at all acquainted with thermometrical observations, of the ab- 
solute inutility of such an arrangement to give any thing more than an approxi- 
mation to the actual temperature. 

" The other instrument from which, I believe, some of the published data 
were derived, is suspended, if possible, in a still more objectionable and absurd 
situation; that is, under a piazza of stone, the whole interior of which is white- 
washed, so that a constant reflection was thrown upon it when the sun shone. 
Both of these instruments, in every instance in which I compared them, indi- 



American Intelligence. 283 

cated a considerable difference between each other, as well as varying from the 
one from which I kept the register below. 

" The hour of the day, (2 o'clock,) at which the middle observation was 
taken, is far from expressing the highest range of heat, and it was solely on the 
ground of convenience that its selection was defended. In a series of observa- 
tions made for the purpose, I invariably found a fall of the thermometer after 
about 1 o'clock. This error has given the climate an appearance of considera- 
bly greater uniformity than it actually possesses, and it has been on this point, 
its boasted evenness, that visitors have been most deceived. The Rev. Dr. 
Porter, of Andover, whose letter on the climate, &c. of St. Augustine, was cir- 
culated by those interested far and wide, was induced to believe, (though I am 
unable to divine on what grounds, or from whom he could have derived his in- 
formation,) that a change of 12° in the twenty-four hours was very unusual, and 
that changes greater than this were almost unknown. So far from such being 
the case, the examination of my table of memoranda for Jan. and Feb. 1831, 
will demonstrate the fact that there was hardly a day in which as great change 
was not noticed, as well as repeated days when the variation was from 20° to 
30° in the twelve hours of day-time; and had the observation at meridian and at 
the coldest part of the night been recorded, the inconstancy of the temperature 
would have been still more palpably striking. Some sudden changes will be 
noticed in the table which could not be surpassed in the mutable climate or 
New York. 

" It has also been frequently observed by visitors how remarkably sudden and 
uncomfortable a change of temperature is produced by the passage of a cloud 
before the sun's disk. It was no uncommon circumstance for a fall of 70° to 
10° to be produced in about as many minutes. 

" The pretended mildness of the nights has been a point on which much stress 
has been laid, constituting, as one circular remarks, 'the secret of the climate. In 
other climates, the night is almost invariably, and is always liable to be, colder 
and damper than the day. In St. Augustine, the reverse is the case, and thus the 
delicate lungs of a patient are secure from one of the greatest sources of irrita- 
tion/ I can state that during the whole of my residence there, this was by no 
means the fact, nor do I believe, from the inquiries I made, that it ever is during 
the winter season. From the nature of my duties I had opportunity to notice 
the weather during almost every night, and can therefore speak with positive- 
ness on this subject. During a portion of the summer months, it may be the 
case that the nights are not cooler than the days, and I am inclined to believe 
that the cooling effect of the daily trade winds, during what would otherwise 
be the intolerably hot season, has not been much exaggerated. This advantage 
however, is of very little moment to pulmonary invalids, very few of whom could 
be induced by any consideration to think of spending the year there, when the 
season of summer and early autumn offers no objection to a residence in the 
northern or middle states. 

"No barometrical or hygrometrical observations have ever been registered 
at this place. 1 am persuaded that when they shall be, the boasted dryness of 
the atmosphere will be found to rest on no better evidence than its freedom from 
atmospherical vicissitudes. 

"I did not commence keeping a register with regularity till some time after 
my arrival; not indeed, till I was convinced how erroneously and unfairly the 
former observations had been made. During this period, I would remark that 
a cold N. E. storm prevailed for about a week, followed by a warm, foggy at- 
mosphere, in which the thermometer was as high as 74° several times, and a 
few days subsequently as iow as 36° — white frost was also noticed. 

"The thermometer, a register of which follows, was suspended at a northerly 
exposure, and in shade throughout the day-" 



284 



QUARTERLY PERISCOPE. 

Register of the Thermometer. 





Date, at 7. 


at 2. 


at 7. 


Winds and remarks. 


Jan. 


16 


38 


46 


48 


Cold west wind. 




17 


26 


40 


32 


N. W. 




18 


21 


45 


38 


At 3 o'clock, A. M. 25°— At 6 A. M. 22°. 




19 


34 


53 


42 


At 6 A. M. 28°— At 10 A. M. in the sun, 93°! 




20 


33 


62 


48 


White frost. 




21 


42 


64 


59 


Cloudy. Wind S. W. 




22 


56 


52 


50 


Rain in the night. 




23 


32 


57 


46 


E.— Cloudy. 




24 


43 


68 


52 


N. W. Do. [shade, 56°! 




25 


42 


64 


49 


At 10^- A. M. in the sun, 102°, same time in the 




26 


36 


68 


54 


S. E. 




27 


44 


76 


57 


Flying clouds. 




28 


47 


74 


61 


S.— Cloudy after M. 




29 


63 


73 


67 


Tremendous gale last night — showers A. M. 




30 


54 


63 


56 


Cold easterly storm. 




31 


65 


73 


54 


S. thick, with showers. 


Feb. 


1 


48 


69 


58 


Heavy fog A. M. 




2 


50 


76 


59 


E. [P. M. wind W. 




3 


65 


80 


74 


Violent E. wind through the night — thick clouds. 




4 


43 


50 


41 


Rain last night. In sun, at 1 F. M. therm. 90°. 




5 


38 


45 


44 


At 3 P. M. commenced snow and hail. Wind N. 




6 


54 


55 


54 


Thick cloudy. [therm, at 43°, cont'd 10 m. 




7 


40 


46 


45 


Do. do. 




8 


42 


56 


46 


Do. with rain. 




9 


43 


58 


48 


Do. 




10 


39 


51 


44 






11 


41 


69 


48 


[the sun, obscurely seen. 




12 


46 


51 


43 


Thick flying clouds. Wind E. Great eclipse of 




13 


53 


64 


50 


Wind N. E.; flying clouds. 




14 


52 


76 


58 


S. — cloudy, hazy. 




15 


60 


67 


60 


E. — cloudy, rain. 




16 


63 


72 


63 


E. — do. do. with heavy thunder. 




17 


53 


69 


49 


W. — clear at morning; P. M. cloudy and rain. 




18 


48 


63 


48 


N. 




19 


54 


62 


56 


N. — cloudy in part. 




20 


53 


70 


54 


N. E. flying clouds. 




21 


61 


77 


60 


Cloudy P. M. 




22 


62 


76 


68 


Cloudy, with a remarkably dense fog. 




23 


56 


70 


59 


N. In the sun at 1 P. M. therm, at 94°. 




24 


46 


71 


55 


N. W. 




25 


54 


70 


58 


N. W. 




26 


53 


71 


58 


N. W. and round to E. 




27 


54 


75 


62 


S. E. 




28 


60 


72 


59 


Heavy rains A. M., clear at 1 P. M. 


March, 


1 


58 


64 


54 


E. — cloudy. 




2 


56 


70 


62 


S. W. 




3 


57 


1 




N. E. 



" Were the question asked me, if I saw or heard of any well-authenticated in- 
stance of consumptive disease cured, relieved or protracted by any ' curative 
effect,' of this climate, truth would compel me to say I saw or heard of none, 
nor have I a doubt that many individuals, who were seduced there by misrepre- 
sentations, did not actually live as long as they would have done at the north; — 
the fatigues, exposure, want of medication, nursing, proper diet, &c. during an 
inclement winter passage on a dangerous and harbourless coast, added to the 



American Intelligence. 285 

severe disappointment of finding none of their expectations fulfilled as to the 
place itself, undoubtedly accelerated the inevitable fate of the consumptive. 

" To the individual labouring- under well-marked consumption, using the 
term in its widest sense as characterizing the various forms of chronic pulmo- 
nary disease, the best advice I could offer as to change of climate would be the 
oriental benediction, ' May you die at home!' To those in the incipient stage, 
or strongly threatened, I would urge my conviction, that a well-regulated arti- 
ficial temperature, and judicious medical and dietetic treatment, (and I may 
here, I hope without invidiousness, express my belief that pulmonary diseases 
are no where so well treated as in New England,) offer far greater hopes of re- 
lief than sea-voyaging or change of climate. 

"The use of the stethoscope, for a want of an acquaintance with which, no 
apology can now be offered by the practitioner, certainly has thrown so much 
light upon, at least, the hopeless forms of consumptive disease, that no patient 
need be sent off in ignorance of his incurable state, to endure the miseries, pri- 
vations, and disappointments of another climate." 

Experiments on Nicotiana Tabacum and Nicotine. By Joseph C. Turnpenny. 
—In order to illustrate the properties of tobacco, and its proximate principle, 
nicotine, I have carefully performed the following experiments. 

( ■ Experiment 1. To half a pound of green tobacco, freshly gathered from 
the plants, eight ounces of pure water were added, in which it was digested 
three days; after which it was subjected to filtration and pressure. To the 
liquor thus obtained, about half a drachm of recently calcined magnesia was 
added, in order to discharge the nicotine from its natural combination in the plant. 

"This infusion was then boiled a few minutes after the addition of the magne- 
sia? when cold the clear liquor was decanted. While hot, the smell of tobacco 
was much more decided than a decoction of the same would have been without 
the addition of magnesia. The decanted liquor was introduced into a re- 
tort and submitted to distillation by the aid of an oil bath, temperature about 
300° Fahrenheit; the nicotine passed over with the water, giving to it a slight 
amber colour. It commenced passing at the temperature of 260°, and its pas- 
sage was very rapid at 325°. In operating on green tobacco, the process is 
much retarded by the presence of substances giving to the infusion a disposi- 
tion to froth, and to throw itself into the neck of the retort. The amber-co- 
loured liquor was strongly characterized by the odour of the purest kind of 
tobacco, and when agitated with sulphuric ether, (62° Baume,) after decanta- 
tion and evaporation, yielded a few grains of a slight yellow extract about the 
consistence of molasses, having a powerful odour of tobacco, sufficiently strong 
to excite, with energy, the nasal organ. The substance above described re- 
stores the blue colour of litmus paper reddened by an acid, and turns curcuma 
paper to a red; it forms combinations with acids in which its odour is restrained. 
It is unquestionably nicotine, slightly coloured by volatile colouring matter pre- 
sent in the plant. 

" Experiment 2. Haifa pound of green tobacco was subjected to digestion 
in eight ounces of water, acidulated with half a drachm of sulphuric acid. After 
three days, this was subjected to filtration and pressure, and the liquor treated 
with sufficient calcined magnesia to neutralize the acid. It was then sub- 
mitted to distillation by the aid of an oil bath, the process being in all respects 
similar to the one already detailed in experiment No. 1; the result correspond- 
ing precisely with the former experiment. 

" Experiment 3. Haifa pound of dry leaves of Kentucky tobacco was di- 
gested four days in pure water, at the temperature of 70° Fahrenheit, after 
which it was strained, and the residue strongly pressed; a highly-coloured li- 
quor charged with tobacco was obtained, of specific gravity 1048.04; to which, 
when raised to the temperature of about 180° Fahrenheit, one drachm of cal- 
cined magnesia was added, and the whole was agitated. After standing' at rest, 
it was carefully decanted, and the clear liquor submitted to distillation by the 
aid of an oil bath, at the temperature of 309° Fahrenheit. The distillation was 

25* 



286 QUARTERLY PERISCOPE. 

effected with comparative facility, and resulted in" the production of a fluid, 
amber-coloured, and highly impregnated with the odour of tobacco. The re- 
sidue, after distillation, which was suffered to cool in the retort, was of the con- 
sistence of molasses, and presented on the sides of the vessel a few granular 
crystals, formed either by the usual salts contained in tobacco, or some new 
compound occasioned by the introduction of magnesia. 

"The amber-coloured liquor, when treated with sulphuric ether of 62° 
Baume, afforded by evaporation a substance of the consistence of honey, very 
slightly coloured, and powerfully impregnated with the odour of tobacco? this, 
when evaporated nearly to dryness, yielded a granular mass. 

" Experiment 4. The dried leaves of Kentucky tobacco, in quantity the same 
as in experiment 3, were submitted to water acidulated with sulphuric acid; 
after digesting four days, at the temperature of 70° Fahrenheit, the liquor was 
separated, and more than sufficient calcined magnesia added to neutralize the 
sulphuric acid. The clear liquor was submitted to distillation by the means of 
an oil bath, as in the last experiment, and the amber-coloured liquor was ob- 
tained, affording by the use of ether, the same product as there detailed. 

" Experiment 5. The aromatic substance obtained by ether from the distilled 
amber-coloured liquors was combined with diluted sulphuric, hydrochloric, tar- 
taric, oxalic and acetic acids? in each of the saline compounds, the aromatic 
odour was decidedly controlled by the acid, and almost suppressed in the sul- 
phate, oxalate, and tartrate. When evaporated nearly to dryness, in several of 
the salts granular formations occurred, but no well-defined crystals. 

" Experiment 6. The concentrated infusion of tobacco, as directed by the 
Edinburgh Dispensatory, was submitted to distillation by means of an oil bath, 
a liquor was obtained of a light amber colour, charged with the peculiar aroma 
of tobacco? (not so decidedly as that obtained after the introduction of calcined 
magnesia into the infusion, in a previous experiment,) this liquor changed cur- 
cuma paper to a light brown, which a diluted acid restored to its original colour. 
Litmus paper, reddened by an acid, was also restored by this liquor to its origi- 
nal colour. Tincture of nut-galls produced a copious light-yellow precipitate. 

" This liquor, after remaining forty-two days, had not in the least changed its 
appearance. It is difficult to account for the substance said to have been produced 
by Hambstadt in the experiments alluded to by the Edinburgh Dispensatory; 
particularly as the nicotine is very soluble in water, and does not crystallize. 

" Experiment 7. The products from the infusions of tobacco were submitted 
to distillation after having been nearly exhausted by sulphuric ether, of 62° 
Baume, were saturated with dilute sulphuric acid, and then evaporated at the 
temperature of 212° Fahrenheit; a thick coloured extract was the result with 
traces of crystalline forms — this extract, when perfectly dry, was submitted to 
anhydrous alcohol, (about 40° Baume,) from which the sulphate of nicotine 
was obtained in solution, and a small portion of sulphate of ammonia, in dis- 
tinct crystals, were left undissolved. The ammonia resulted from the reaction 
of the magnesia on a salt of ammonia contained in the infusion of tobacco, and 
its combination with sulphuric acid from the addition of the latter previous to 
the evaporation above alluded to. 

" The following experiments illustrate the physiological character of nico- 
tine, and although foreign to the science of pharmacy, I consider of sufficient 
interest to be recorded. 

" Experiment 8. About one-sixteenth of a grain of hydrochlorate of nicotine 
was given to a healthy mouse. The symptoms which immediately ensued were 
violent spasms of the limbs and body, laborious breathing, great prostration, 
nausea, inclination to sleep, pupils largely dilated, weakness in the extremities, 
especially the posterior, and in the course of a few hours the animal died. 

" Experiment 9. To a healthy mouse, a minute portion of the oxalate of 
nicotine was given on the point of a large needle; a narcotic effect was imme- 
diately produced — laborious breathing and vomiting. In the course of half an 
hour the animal recovered. 

"Experiment 10. To a half grown healthy cat, about one-eighth of a grain of 



Jlmeriwn Intelligence. 287 

the hydrochlorate of nicotine, dissolved in water, was given. An almost instan- 
taneous evidence of the influence of a powerful narcotic was manifested, fol- 
lowed by prostration, with nausea and vomiting' — first, the contents of the sto- 
mach, then frothy mucus, with violent retching 1 . The head was inclined down- 
wards, and the pupils dilated. The animal having vomited five or six times, 
gradually recovered, and appeared perfectly well thirty minutes after the exhi- 
bition of the nicotine. 

" Experiment 11. To the same cat about half a grain of the hydrochlorate of 
nicotine was given, dissolved in water; all the symptoms of a narcotic charac- 
ter evinced as before, were now manifested in the most aggravated form; the 
ears were drawn closely down upon the back of the head, she made one or two 
efforts to walk, when she fell, in a state of the greatest prostration, with slight 
convulsions of the posterior extremities; evacuation of the contents of the rec- 
tum, the ears recovering their natural position, but not their sensibility to the 
touch; the posterior extremities seemed no longer to be under her controul; 
being thrown in an opposite direction to that of the anterior, thereby giving a 
spiral twist to the back; pupils fully dilated; squinting of the eyes, turned up- 
wards and outwards; alternately laborious, hurried breathing, with rattling in 
the lungs and deep inspirations. In this apparently dying state, she laid about 
thirty minutes, after which she gradually recovered, making violent efforts to 
vomit, ejecting small quantities of frothy mucus. In the space of sixty minutes 
she had command of her extremities, but still manifested inclination to coma, 
with want of appetite. In about three hours, she had entirely recovered, with 
the exception of great weakness, and took food with avidity." — Journal of the 
Phil. College of Pharmacy, Oct. 1833. 

Cholera. — It has been doubted by some physicians that cholera ever appear- 
ed in the open country, and in sequestered farm houses; the following statement 
by the able editor of the Western Journal of the Medical and Physical Sciences 
is conclusive on this point, and furnishes moreover other information relative 
to the disease of considerable interest. The proofs which Dr. Drake alludes 
to, as adduced in favour of the contagiousness of cholera, appear to us to have 
even less force than he attaches to them. 

" For several weeks the northern parts of Kentucky have been ravaged by 
the Epidemic. It seems to have extended from the river, at Maysville, into the 
interior, and yet it appeared at Lexington and Georgetown, before it broke out 
in Paris and Millersburgh, towns which lie on the great road leading to the an- 
cient metropolis of the state. It is, however, by no means confined to the vil- 
lages, but invades the most sequestered farm houses, where, in many instances, 
it has been more fatal, than in the towns. Among other spots it has put forth 
its power at the Blue Licks and Harrodsburg, old and salubrious watering 
places; at which not a few were assembled, under the delusive impression, 
that it would not visit such spots. So far from being safe situations, however, 
we have understood that the salino-sulphur waters of the Blue Licks, which 
operate as a cathartic, were found in several cases to be an exciting cause. 

" In all the towns and villages of the region where it prevails, a flight has been 
the consequence of its first appearance. The idea of contagion seems to have 
been uppermost in the public mind; and escape, regarded as the only preven- 
tive. Even the medical mind of that district of country, has been mystified by 
the same phantom; and in several places, the physicians have not only recom- 
mended flight to the inhabitants, but have actually flown themselves; leaving 
those who could not escape, to grapple with the danger as they might! It is 
with pain we record such circumstances; but they make a part of the history 
of the Epidemic, and throw much light on the causes of its great mortality, in 
a tract of country, where from the dryness of the calcarious soil, the abundance 
of subsistence, the comfortable style of living, the orderly habits, and the gene- 
ral intelligence of the people, a mitigated visitation might have been reason- 
ably anticipated. 

"Last summer the same portion of the state was visited by the Epidemic, in 



288 QUARTERLY PERISCOPE. 

the form of a mild diarrhoea, and in autumn a number of deaths occurred in 
Maysville, Lexington, and other towns; but it was decidedly fatal in Frankfort 
only; which, it is worthy of remark, remains almost unaffected the present 
summer, although most of the surrounding- villages and farms are sorely afflict- 
ed. The same is true, in nearly an equal degree, of Louisville, which suffered 
much more, last autumn, than during the present spring and summer. 

" We have said, that the epidemic seemed to advance into Kentucky from the 
Ohio river; from the same, it has appeared to advance into the state of Ohio. 
Many of the towns and villages on both banks of the river have been invaded, 
and are now suffering, quite up to Pittsburg, which, although defended by a 
quarantine battery, eight or ten miles below the city, has had a number of 
cases. At Wheeling, not less than in Maysville, it was more severe and fatal. 
At Bridgeport, opposite the former, it proved suddenly and dreadfully mortal, 
though on the first day, almost all the inhabitants fled. Steubenville, Gallipolis, 
and other smaller towns, as New Richmond, twenty miles above Cincinnati, are 
now suffering more or less. In the rear of all these places, indeed, in the 
southern portions of the state of Ohio, generally, as in the northern parts of 
Kentucky, it is daily manifesting itself in some new locality. Thus it seems, 
like the exhalations of the river, to spread from its valley over the adjoining 
parts of these two states, and equally, as we understand, over Indiana and Illi- 
nois. Indeed the region of country through which the river runs, is that, where, 
in the west, the disease is now most prevalent; its banks were the first affected, 
its bed seems to be the nidus of the pestilence. Thus the spread of cholera in 
this country, affords, as it has afforded in all others, much prima facie evidence 
of contagion— evidence which the credulous think conclusive, and the most 
philosophical find perplexing. 

" To this seeming proof of contagious dissemination, we may oppose the 
unquestionable facts,— that diarrhoea or cholerine is generally prevalent through- 
out the same region; that fatal cholera has occurred, nearly at the same time, in 
places remote from each other; that the epidemic distemperature appeared 
along the great rivers, on nearly the same days, from the Gulf of Mexico to the 
mountains; that some villages, at which steam boats have constantly landed, 
have not yet been attacked; that villages comparatively near to, and in constant 
intercourse with, towns where the disease prevailed, still remain unaffected, 
while others more remote are laid waste; as for example, Mayslick, twelve 
miles from Maysville, on the Lexington road, which remains untouched, while 
Flem'msburg-, eight miles further off, and remote from the great highway, has 
already suffered to a degree seldom equalled any where; finally, that the expe- 
rience of every day augments the number of cases, which could not have been 
contracted by exposure to others labouring under the malady. 

"Now, if any case of cholera arise, independently of contagion, every case 
may, and from the moment when it is shown, that the disease can be produced 
without contagion, it is sound medical logic to conclude that no such principle 
exists. This conclusion, however, must not be regarded as definitive and final, 
unless it is shown, that a disease, which sometimes originates from some other 
cause than contagion, can never originate from that cause. Still, it is incum- 
bent on the contagionist to make out every case by special proofs; but in at- 
tempting this, they must necessarily labour under this disadvantage — that as the 
atmosphere is impregnated with a poison which sometimes, at least, produces 
the disease, it is impossible, in the case in which it follows exposure to a cho- 
leric chamber atmosphere, to know whether the disease really arose from that 
cause. The individual might have been attacked from the other cause if he 
had not been subject to contact with the sick. In the case of one individual, 
only, this presumption might always be made; but what shall we say of those 
well-authenticated instances in which several members of a family, and some- 
times the visitors, are successively taken down, in places where the disease is 
not prevailing? There are examples of this kind which, we must acknowledge, 
are embarrassing to the non-contagionists; but they do not establish the existence 
of contagion — they only render it probable.' 5 



American Intelligence, 289 

Cephalic Bellows-Sound. — The September No. of our cotemporary, the Medi- 
cal Magazine, contains some highly interesting- observations by Dr. John Fisheii 
of Boston, on a bellows-sound observed in the head. This sound was first dis- 
covered by him in July, 1832, in a child two and a half years of age, affected 
with chronic hydrocephalus. On applying his ear to this child's head, to his 
surprise he heard a very loud and distinct bellows-sound, resembling that 
caused by certain diseases of the heart. Dr. Fisher has since met with it in 
five other cases of cerebral affections, in all of which the sound was very dis- 
tinct. Whether it be present in all diseases of the brain, Dr. Fisher has not 
yet ascertained. <l Having heard the sound," he remarks, " a second time, the 
idea occurred to me that it might be a normal one, and the unceasing result 
of health. To determine this point I immediately began to examine the heads 
of healthy persons of all ages, and from many careful and repeated observations 
I find that in children, previous to the commencement of dentition, auscultation 
discovers no sound in the head resembling the bellows-sound. The sound pro- 
duced by the impinging of the air during respiration, against the walls of the 
nasal cavities; those produced by the act of swallowing and of speaking, and 
by the heart's motions, can be easily heard and distinguished from each other. 
In children during the process of dentition I have, besides the sounds just 
mentioned, frequently detected a cephalic bellows-sound. The sound was not 
present in all teething children, but in those only who suffered much from the 
process of dentition. And in these, the cephalic bellows-sound differed some- 
what from that which was heard in the patients who died of dropsy in the 
brain, in being more abrupt, shorter and less diffused. It might have been de- 
nominated the bruit de rape rather than bruit de soufflet, as it resembled more 
strikingly the action of a file than of a bellows. And in no instance have I noticed 
it to pass into a continuous murmur or to assume a musical tone. It maintained 
one uniform character. 

" It was in the early period of the first dentition and previously to the closure 
of the anterior fontanelle, that the sound was most frequently and distinctly 
heard. In one instance only have I heard it, after the development of the first 
twenty teeth; and in this one instance the boy was cutting the remaining double 
teeth. Neither in healthy adults or aged persons have I been able to detect the 
sound, although I have repeatedly and with great attention auscultated the 
heads of such subjects to ascertain if it did exist in them. I have not as yet dis- 
covered that the cephalic bellows-sound accompanies any malady, other than 
those which mediately or immediately affect the brain. In a case of severe 
peripneumony, however, I recollect that the sound existed. It was loud and 
well-marked, and was heard by Dr. James Jackson, who saw the child with me; 
but the little patient was cutting its teeth and had suffered much from the pro- 
cess. In two cases of hooping cough I noticed the sound very distinctly, when 
I applied my ear upon the patient's head at the instant the paroxysm of cough- 
ing ceased. The sound continued but for a moment, and only while the face 
continued to be flushed by the accumulation of blood in and about the head. 
I have seated myself for a long time by the child, and waited patiently for the 
return of the fit of coughing that I might, by repeated observations, satisfy my- 
self of the truth of the fact above stated. In every instance of severe cough- 
ing the sound was produced, but it disappeared as soon as the child began to 
breathe freely, and the circulation became again unobstructed and natural. Such 
are the facts which I have collected in relation to this new phenomenon." 

Dr. Fisher thinks, that it is clearly proved from the observations made in the 
six cases in which he has observed the cephalic bellows-sound, that this sound 
originates in the arteries. "For in the first place," he observes, " the sound 
was distinct from that produced by respiration, by deglutition, muscular action, 
or any other operation going on within the head, that we can conceive of, save 
arterial action. Secondly, it was synchronous with the pulsations and impulse 
of the heart, and of the carotid and temporal arteries, and also with the rising 
and impulse of the brain as observed by placing the finger upon the unclosed 
fontanelle. Thirdly, the sound ceased to be heard, or at any rate was rendered 



290 QUARTERLY PERISCOPE. 

less distinct, by compressing- the carotid arteries and arresting" the circulation 
in them, and it became less audible as the patient grew weak and the pulse 
feeble. Fourthly, it resembled in all respects the bruit de soufflet which we 
hear in diseases of the heart and of the arteries, and particularly in aneurism of 
the latter vessels. Fifthly, in looking- at the structure and composition of the 
organs contained within the cranium, we must be convinced that the arteries 
were the only organs which could have sent forth a bellows-sound like those I 
have noticed. Assuming it as proved that the sound proceeded from the ar- 
teries, I may further observe that those situated at the base of the brain, were 
probabty the ones in which it originated. I infer this from a consideration of 
the distribution of the arteries within the head. Anatomy teaches us that all 
those of any considerable size are situated at the base of the brain, and rest 
upon unyielding bony structure. Having passed through their appropriate 
apertures and osseous canals, they course along upon the base of the skull and 
in furrows formed for them in the brain, and soon subdivide and spread them- 
selves upon the pia mater, and do not actually enter the substance of the brain 
until they become mere capillary vessels. There is, therefore, no artery exist- 
ing in the cerebral substance, and no one running over its surface, of sufficient 
caliber to send forth a bellows-sound as distinct and audible as were those I 
have heard. For to produce a bellows-sound in an artery artificially, I find that 
the artery must be of considerable size, and must rest upon rather an unyielding 
surface, otherwise it will not be placed in a condition necessary for the produc- 
tion of the sound. A further proof that the arteries at the base of the brain 
were the seat of the phenomenon, is derived from the motions of the brain as 
seen and felt at the fontanelle. These are evidently caused by the pulsations 
of the arteries on which the organ rests. The bellows-sound always accompa- 
nies and is synchronous with the elevation of the cerebral mass; and as there is 
no other cause to account for- this, it follows that the sound must have arisen 
from these vessels. The facility with which it was heard at the summit of the 
cranium is no argument against this conclusion. For the brain is an excellent 
conductor of sound, as is proved by the fact that it readily transmits the noise 
produced by the action of a watch. If then the bellows-sound proceeded from 
the arteries at the base of the brain, its production in the cases I have men- 
tioned maybe readily accounted for. It is now a well-established fact, that the 
bellows-sound of the heart and of the arteries arises from an impediment to the 
flow of the blood through these organs. The cephalic bellows-sound which I 
have described, unquestionably arose from such a cause. In all the cases in 
which it was present, there was either dropsy of the brain, or a congestion of 
the blood-vessels within it; and the brain being incompressible and acted upon 
by these causes, was forced against the arteries at its base, and must have con- 
tracted them at certain points. This condition of the arteries obstructed in a 
degree the passage of the blood through them, and was the immediate cause 
of the cephalic bellows-sound. If this be the true explanation of the existence 
of the sound, we may expect its presence in all diseases which may in any con- 
siderable degree compress the brain, and we may perhaps venture to hope that 
a physical sign has been discovered, which will prove to be a pathognomonic 
symptom of cerebral disease." 

Bourgery's Petite Chirurgie. — We are happy to announce that a translation 
by Drs. W. C. Roberts and J. B. Kissam of this excellent work, is now in 
the press. Its publication may be expected in the course of the ensuing month. 

Baltimore Medical and Surgical Journal and Review. — Just as this form was 
preparing for press, we received the first No. of this work, of course too late to 
do more than just glance at its contents. From the known talents and indefa- 
tigable industry of its editor, E. Geddings, M. D., however, no doubt can be 
entertained of the value of its contents, and of the ability with which it will be 
conducted. We shall have the pleasure of introducing it more particularly to 
our readers in our next. 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



No. XXVI.— Feb. 1834. 26 



COLLABORATORS. 



Jacob Bigelow, M. D. Professor of 
Materia Medica in Harvard Univer- 
sity, Boston. 
Edward H. Barton, M. D. of New 

Orleans. 
Henry Bronson, M. D. of Albany, New 

York. 
Waiter Chaining, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard University, Boston. 
N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 
John Redman Coxe, M. D. Professor 
of" Materia Medica and Pharmacy in 
the University of Pennsylvania. 
D, Francis Condie, M. D. of Phila- 
delphia. 
William C. Daniell, M. D. of Savan- 
nah, Georgia. 
William P. Dewees, M. D. Adjunct 
Professor of Midwifery in the Univer- 
sity of Pennsylvania. 
S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of the state of 
South Carolina. 
Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 
Gouverneur Emerson, M. D. of Phila- 
delphia. 
Paul F. Eve, M. D. Professor of Sur- 
gery in the Georgia Medical College. 
John W. Francis, M. D. Late Profes- 
sor of Obstetrics and Forensic Medi- 
cine in Rutgers Medical College, New 
York. 
W. W. Gerhard, M. D. of Philadelphia. 
William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 
R. E. Griffith, M. D. of Philadelphia. 
E. Hale, M. D. of Boston. 
Robert Hare, M. D. Professor of Che- 
mistry in the University of Pennsyl- 
vania. 
George Hay ward, M. D. Junior Sur- 
geon to the Massachusetts General Hos- 
pital. 
Thomas Henderson, M. D. Professor 



of the Theory and Practice of Medi- 
cine in the Columbian College, Dis- 
trict of Columbia. 

William E. Horner, M. D. Professor 
of Anatomy in the University of 
Pennsylvania. 

David Hosack, M. D. Late Professor 
of the Institutes and Practice of Medi- 
cine in Rutgers Medical College, New 
York. 

Ansel W. Ives, M. D. of New York. 

Samuel Jackson, M. D. Assistant to the 
Professor of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania. 

Valentine Mott, M. D. Professor of 
Pathological and Operative Surgery 
in the College of Physicians and Sur- 
geons, New York. 

James Moultrie, Jr. M. D. Professor 
of Physiology in the Medical College 
of the state of South Carolina. 

Reuben D. Mussey, M. D. Professor 
of Anatomy and Surgery in Dart- 
mouth College, New Hampshire. 

T. D. Mutter, M. D. of Philadelphia. 

R. M. Patterson, M. D. Professor of 
Natural Philosophy in the University 
of Virginia. 

Philip Syng Physick, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Co- 
lumbian College, District of Colum- 
bia. 

Ashbel Smith, M. D. of Salisbury, 
North Carolina. 

A. F. Vache, M. D. ofNeiv York. 

John Ware, M. D. Assistant Professor 
of the Theory and Practice of Physic 
in Harvard University, Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer on Ana- 
tomy and Surgery, New York. 

Thomas H. Wright, M. D. Physician 
to the Baltimore Aims-House Infir- 
mary. 



EDITOR— Isaac Hays, M. D. 



TO READERS AND CORRESPONDENTS. 

Communications have been received from Professor Horner, Dr. Jackson, 
Dr. Ticknor, Dr. Hull, and Dr. Dudley. 

Several articles prepared for this No. have been omitted for want of space, 
though we have extended the No. twelve pages beyond our limits. 

The following works have been received: — 

The Dispensatory of the United States of America. By George B. Wood, 
M. D. &c. and Franklin Bache, M. D. &c. Second edition, enlarged and care- 
fully revised. Philadelphia, 1834, Gregg & Elliot. (From the publishers.) 

Illustrations of Pulmonary Consumption; its Anatomical Characters, Causes, 
Symptoms and Treatment. With twelve plates, drawn and coloured from na- 
ture. By Samuel George Morton, M. D. Physician to the Philadelphia Alms- 
house Hospital; Lecturer on Anatomy, &c. &c. &c. Philadelphia, 1834. (From 
the author.) 

Experiments and Observations on the Gastric juice, and the Physiology of 
Digestion. By William Beaumont, M. D. Surgeon United States' Armv, 
Plattsburgh, 1833. (From the author.) 

Medico- Chirurgical Transactions, Published by the Medical and Chirurgical 
Society of London. Vol. XVIII. London, 1833. (From the society.) 

Recueil de Memoires sur le Typhus Nautique, ou Fievre Jaune, Provenant 
principalement de 1'Infection des Batimens Negriers. Par M. Audouard, D. 
M. M. Envoye a Barcelone en 1821, et au Port du Passage en 1823, par S. E. 
le Ministre de la Guerre, a l'occasion de la Fievre Jaune, &c. Paris, 1825-26. 
(From the author.) 

An Essay to prove the Contagious Character of Malignant Cholera; with 
Brief Instructions for its Prevention and Cure. By Bernard M. Byrne, M. D. 
Baltimore, 1833. Carey, Hart & Co. (From the publishers.) 

The Infirmities of Genius, illustrated by referring the Anomalies in the Lite- 
rary Character to the Habits and Constitutional Peculiarities of Men of Genius 
By R. R. Madden, M. D. 2 vols. Carey, Lea & Blanchard, 1833. (From the 
publishers.) 

Catalogue of the Trustees, Faculty, and Students of the Berkshire Medical 
Institution, and of the Alumni and Honorary Graduates, since its incorporation 
in 1823. Pittsfield, Mass. 1833. (From Professor H. H. Childs, M. D.) 

A Treatise on the Venereal Disease and its Varieties. By William Wal- 
lace, M. R. I. A. &c. London, 1833. (From the author.) 

The Hand, its Mechanism and Vital Endowments as Evincing Design. By 
Sir Charles Bell, K. G. H. F. R. S. L. & E. Philadelphia, Carey, Lea & Blan- 
chard, 1833. (From the publishers.) . 

Introductory Lecture, delivered on the 11th of November, 1833. By Samuel 
Henrt Dickson, M. D. Professor of the Institutes and Practice of Medicine in 



296 TO READERS AND CORRESPONDENTS. 

the Medical College of South Carolina. Published by the students. Charleston, 
1833. (From the author.) 

An Introductory Lecture delivered to the Medical Class of the University of 
Maryland, on Friday, October 31st, 1833. By Roeley Dtjnglison, M. D. Pro- 
fessor of Materia Medica, Therapeutics, Hygiene, and Medical Jurisprudence 
in the University of Maryland. Published by the Medical Class. Baltimore, 
1833. (From the author.) 

Lettre de M. Souberbielle, a 1'Academie des Sciences, sur la Statistique des 
Affections Calculeuses, presente par M. Civiale, dans la seance du 26 Aout, 
1833. (From the author.) 

A Treatise on Lesser Surgery, or the Minor Operations. By Botjrgery, D. 
M. P. Translated from the French, with Notes and an Appendix. By William 
C. Roberts and James B. Kissam. New York, 1834. (From the translators.) 

An Address Introductory to a Course of Lectures delivered in the Hall of 
the Medical College of South Carolina, before the Trustees and Faculty, the 
Students of Medicine, and the Public generally, at the opening of the Session 
of 1833-4. By Gunning S. Bedford, M. D. Professor of Obstetric Medicine and 
the Diseases of Women and Children. Published at the request of the Trustees 
and the Students of Medicine. Charleston, 1833. (From the author.) 

A Catalogue of the Officers and Students of Dartmouth College. October, 
1833. (From Professor Mussey.) 

A Catalogue of the Officers and Students of Transylvania University. Lex- 
ington, Kentucky. January, 1834. (From Professor C. W. Short.) 

The Dissector's Guide, or Student's Companion. Illustrated by numerous 
wood cuts, clearly exhibiting and explaining the dissection of every part of the 
human body. By Edward W.Tuson, F. L. S. &c. Lecturer on Anatomy and Phy- 
siology at the Little-Windmill-street school. First American edition, with addi- 
tions. By Winslow Lewis, Jr. M. D. Demonstrator of Anatomy to the Medi- 
cal School of Harvard University. Allen and Ticknor, Boston, 1833. (From 
the publishers.) 

Annales de la Medecine Physiologique. November, December, 1832, Janu- 
ary, February, March, April, May, 1833. (In exchange.) 

Archives Generates de Medecine; Journal Complementaire des Sciences Me- 
dicale. January to August, 1833. (In exchange.) 

Transactions Medicales; Journal de Medecine Pratique. January to August, 
1833. (In exchange.) 

Journal Universel et Hebdomadaire de Medecine et de Chirurgie Pratiques 
et des Institutions Medicales. March to September, 1833. (In exchange.) 

Journal de Chimie Medicale de Pharmacie et de Toxicologic January to 
September, 1833. (In exchange.) 

Journal de Pharmacie et des Sciences accessoires. January to September, 
1833. (In exchange.) 

Revue Medicale Frangaise et Etrangere, Journal de Clinique de l'Hotel-Dieu, 



TO READERS AND CORRESPONDENTS. 297 

de la Charite et des grands Hopitaux de Paris. January to August, 1833. (In 
exchange.) 

Journal des Connaissances Medico-Chirurgicales, September, 1833. (In ex- 
change.) 

Gazette Medicale de Paris, January to September, 1833. (In exchange.) 

La Lancette Frangaise Gazette des Hopiteaux, civils et militaires. January 
to October, 1833. (In exchange.) 

Heidelberger Klinische Annalen. Nos. 1, 2, 3 and 4, for 1832. (In exchange.) 

Litterarische Annalen der Gesammten Heilkunde herausgegeben von Dr. J. 
F. C. Hecker. For September, October, November, December, 1832, and 
January, 1833. (In exchange.) 

The London Medical and Surgical Journal, for July, August, September and 
October, 1833. (In exchange.) 

London Medical Gazette, for August, September, October, and November. 
(In exchange.) 

Glasgow Medical Journal, Vol. I. No. 2, Vols. IV. and V. and Nos. 1, 2, and 
3. Vol. I. N. S. (In exchange.) 

The Edinburgh Medical and Surgical Journal, for October, 1833. (In ex- 
change.) 

The Medico-Chirurgical Review, for October, 1833. (In exchange.) 

The Medical Magazine, conducted by A. L. Peirson, J. B. Flint, and E. 
Bartxett. For October and November, 1833. (In exchange.) 

The Boston Medical and Surgical Journal, Vol. IX. Nos. 11 to 22, inclusive. 
(In exchange.) 

The Western Journal of the Medical and Physical Sciences, for October, 
1833. (In exchange.) 

The Baltimore Medical and Surgical Journal and Review, for January, 1834. 
(In exchange.) 

Authors of new medical books 3 desirous of having them reviewed or noticed 
in this Journal at the earliest opportunity, are invited to transmit to the Editor 
a copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused by 
the circuitous routes through which they are received. 

Papers intendedfor publication, should be sent, free of expense, as early after 
the appearance of the Journal as possible, in order to be in time for the ensuing 
number. Such communications should be addressed to " Caret, Lea & Blajs- 
chard, Philadelphia, for the Editor of the American Journal of the Medical 
Sciences." 

All letters on the business of the Journal to be addressed exclusively to the 
publishers. 

26* 



CONTENTS. 



ORIGINAL COMMUNICATIONS. 

ESSAYS. 

Aht. Page, 

I. Case of Extirpation of a Tumour of the Neck, in which the Carotid Ar- 
tery and Internal Jugular Vein were Tied — with Remarks. By William 
Gibson, M. D. Professor of Surgery in the University of Pennsylvania. 
[With a plate] 305 

II. On the Medical Uses of the Viola Ovata. By Stephen W. Williams, 

M. D. of Deerfield, Mass. - - - 310 

III. Cerebral Affections of Children. By W. W. Gerhard, M. D. of Phila- 
delphia 313 

IV. On the Communicability of Cholera. By S. Henry Dickson, M. D. 
Professor of the Institutes and Practice of Medicine in the Medical Col- 
lege of the State of South Carolina 359 

V. Cases of Deranged Menstruation, with Remarks. By Harvey Lindsly, 

M. D. of Washington, D. C. 366 

VI. On the Circular and Flap Operation. By R. Tolefree, Jr. M. D. - 370 

VII. Case of Ununited Fracture of the Os Humeri, Successfully Treated 
by the Injection of a Stimulating Fluid into the Wound. By Isaac Hulse, 
M..D. Surgeon U. S. Naval Hospital, Pensacola .... 374 

VIII. Observations on Scarlet Fever, as it Prevailed in Augusta, Georgia, 
during the Winter and Spring of 1832-33. By F. M. Robertson, M. D. 375 

IX. A Case of Ossification of the Muscular Tissue. By David L. Rogers, 
M. D. Lecturer on Surgery in New York. [Communicated by S. R. 
Kirby, M. D] 386 

X. On the Iodo-Hydrargyrate of Potassium; its Chemical History and The- 
rapeutical Uses. By William Channing, M. D. of New York - - 388 

XI. Note of the Post Mortem Examination of a Female who committed 
Suicide almost immediately after Coitus. By H. Bond, M. D. of Philadel- 
phia --.--.-..-.. 403 

XII. On the Anterior Membrane of the Eyeball. By W. C. Wallace, M. D. 
one of the Physicians to the New York Northern Dispensary. [See 
American Intelligence for additional remarks] - - - 404 

XIII. Sequel of the Case of Axillary Aneurism and Ligature of the Subcla- 
vian Artery, inserted in Vol. III. p. 28, of this Journal. By Edward W. 
.Wells, M. D. of Maracaybo - - - - - - - - 406 



300 CONTENTS. 

MEDICAL EDUCATION AND INSTITUTIONS. 
Art. Page. 

XIV. On Medical Education. By Samuel Jackson, M. D. Assistant Lec- 
turer to the Theory and Practice of Medicine and Clinical Medicine in 

the University of Pennsylvania 407 

REVIEWS. 

XV. Memoir of the Life and Medical Opinion of John Armstrong-, M. D. 
Formerly Physician to the Fever Institution of London; Author of "Prac- 
tical Illustrations of Typhus and Scarlet Fever," &c. &c. to which is 
added an Inquiry into the Facts connected with those forms of Fever at- 
tributed to Malaria, or Marsh Effluvium. By Francis Boott, M. D. Secre- 
tary of the Linnsean Society; Honorary Member of the Medical Society 

of Massachusetts. In two volumes. Vol. I. London, 1833 - - 425 

XVI. Nouveau Systeme de Chimie Organique, fonde sur des methodes 
nouvelles d'Observation, par F. V. Raspail. Accompagne de douze 
planches gravees, dont six coloriees. Paris, 1833, pp. 576. 8vo. 

New System of Organic Chemistry, founded on New Methods of Investiga- 
tion. By F. V. Raspail, &c. 452 

XVII. The Hand, its Mechanism and Vital Endowments, as Evincing De- 
sign. By Sir Charles Bell, K. G. II., F. R. S. L. & E. Philadelphia, 
Carey, Lea & Blanchard, 1833. pp. 213 464 

BIBLIOGRAPHICAL NOTICES. 

XVIII. Illustrations of Pulmonary Consumption, its Anatomical Characters, 
Causes, Symptoms and Treatment. With twelve plates, drawn and co- 
loured from nature. By Samuel George Morton, M. D. Physician to the 
Philadelphia Alms-house Hospital, Lecturer on Anatomy, &c. &c. Phila- 
delphia, Key & Biddle, 1834, pp. 183 473 

XIX. Memoir of the Life, Writings, and Correspondence of James Currie, 
M. D., F. R. S. of Liverpool, &c. Edited by his son, William Wallace 
Currie. In two vols. 8vo. London. 1831 - - - - - 483 

XX. A Memoir on the Advantages and Practicability of dividing the Stric- 
ture in Strangulated Hernia, on the outside of the Sac. AVith Cases and 
Drawings. By C. Aston Key, Senior Surgeon to Guy's Hospital, and 
Lecturer on Surgery, &c. London, 1833. pp. 161. - - - 497 

XXI. A Treatise on the Venereal Disease and its Varieties. B)>- William 
Wallace, M. R. I. A., &C. &c. &c, Surgeon to the Jervis street Infirmary, 
Dublin; and to the Infirmary established in that City for the Treatment 
of Cutaneous Diseases, including Venereal Diseases. London, 1833. oct. 
pp. 382. ' 502 

XXII. On Some Points connected with the Anatomy and Surgery of Ingui- 
nal and Femoral Herniae, &c. By G. J. Guthrie, F. R. S. &c. Quarto, 

p. 44. Illustrated by three plates. 508 

XXIII. Manual of Practical Toxicology; condensed from Dr. Christison's 
Treatise on Poisons. With Notes and Additions. By J.T. Ducatel, M. D, 



CONTENTS. 



301 



Art. Page. 

Professor of Chemistry and Pharmacy in the University of Maryland, 
&c. &c. Baltimore, 1833, pp. 341, 12mo. .... 509 

XXIV. Baltimore Medical and Surgical Journal and Review. Edited by 
E. Geddings, M. D. Professor of Anatomy and Physiology in the Uni- 
versity of Maryland, 8cc. No. 1. October, 1833. .... 511 

XXV. Recueil de Memoires sur Le Typhus Nautique, ou Fievre Jaune, 
Provenant principalement de l'infection des Batimens Negriers. Par M. 
Audouard, D. M. M., Envoye a, Barcelone en 1821, et au Port du Pas- 
sage en 1823, par S. E. le Ministre de la Guerre, a l'occasion de la Fievre 
jaune. 

Collection of Memoirs relative to Ship Typhus, or Yellow Fever, produced 
principally by the Infection from Slave Ships. By M. Audouard, 8cc. 512 



QUARTERLY PERISCOPE. 



FOREIGN INTELLIGENCE, 



Anatomy. 



Page. 

1. Absence of the Right Auricle 513 
2* On the Alleged Existence of a 
Ganglion Oticum in Man and 



Quadrupeds. 
Schlemm - 



By 



Page, 
Professor 

513 



Physiology. 



Discovery of a New Principle 
in the Serum of the Human 
Blood. By M. Felix Boudet 514 



4. On the Umbilical Vesicle. By 
Professor Mayer - - 514 



Pathology. 



5. On the Different Sorts of Goitre. 

By Dr. Sacchi 515 

6. Case of Encysted Abscess of the 
Cerebellum communicating out- 
wardly. Dy Dr. Scalvanti - 516 

7. Case of Diphtheritis with Cli- 



nical Remarks. By William 
Stokes, M. D. - - - 517 
Case of Phthisis Laryngea, with 
Remarks. By William Stokes, 
M. D. - - - - 519 



Materia Medica. 



Observations on Local Blood- 
letting and on some New Me- 
thods of Practising it. By Jona- 
than Osborne, M. D. 



521 



10. Croton Oil as a Counter-irritant. 
By Dr. Hutchinson - - 523 



302 



CONTENTS. 



Practice of Medicine. 



Page. 

11. M. Herpin's Cases of Empye- 
ma ----- 523 

12. Pathology and Treatment of 
Gastritis. By Dr. William 
Stokes .... 527 

13. Treatment of Erysipelas with 
Mercurial Frictions. By M. Ca- 
simir Broussais - 533 

14. Inflation of the Bowels. By 
Mr. Blacklock - - - ib. 

15. Iodine in the Treatment of Sa- 
livation .... ih. 

16. Rheumatism Cured by the 
Common Artichoke. By M. 
Copeman - ib. 

17. Inflammation of the Mucous 



Page. 
Membrane of the Bowels. By 
Dr. William Stokes - - 534 

18. On Delirium Tremens. By 

Dr. Stokes '- - - 536 

19. On the Efficacy of Dry Cup- 
ping in Various Diseases. By R. 

J. Graves, M. D. - - 537 

20. Severe Case of Hydrocephalus 
terminating" in Recovery. By 
Dr. Traill - - - 540 

21. Inflation as a Remedy for Ob- 
structed Bowels. By John King, 

Jr. Esq. .-- - 542 

22. Efficacy of Iodine in Dropsy. 

By Dr. William Stokes - 543 



Ophthalmology. 



23. Restoration of Vision, in Cases 
of Staphyloma and Incurable 
Opacity of the Cornea. By Mr. 
Nimmo - 



544 



24. On Xeroma Conjunctivas. 
William Mackenzie - 



Bv 



547 



SURGERT. 



25. Case of Croup in which Tra- 
cheotomy was performed with 
success. By Drs. Trousseau and 
Rue 

26. Dislocation of the Humerus 
backwards. By M. Sediilot 

27. On Abscesses of the Septum 
Narium. By Mr. Fleming - 

28. Fracture of a Rib produced by 
a Violent Fit of Coughing. By 
Dr. Graves - 

29. Parotid Tumour.— Extirpa- 
tion. By James Syme, Esq. 

30. Cancer of the Tongue.- — Exci- 
sion. By James Syme, Esq. 



549 



551 



55: 



554> 



ib. 



31. Medullary Tumour of the 
Bones of the Face, with Ab- 
scess of the Antrum. By James 
Syme, Esq. 

32. Abscess of Perineum, commu- 
nicating with the Urethra after 
its evacuation. By James Syme, 
Esq. ---'-- 

33. On the Obliteration of Veins 
as a Mode of Curing Varices, 
By M. Davats 

34. Retention of Urine produced 
by Imperforate Hymen. By Mr. 
Coley -■'-.-- 



iS5 



J56 



557 



Medical Jurisprudence. 



35. On a peculiar Animal Sub- 
stance produced during the De- 
composition of the Dead Body. 
By MM. Ollivier d'Angers and 
A. Chevallier - 



558 



36. On the Presence of Copper 
in Wheat and several other sub- 
stances. By M. Boutigny - 559 

37. Weight of Man at different 
Ages. By M. Quetelet - 560 



Miscellaneous. 



3. On the Transmission of Me- 
dicaments into the System by 
Means of Electro-Galvanism. By 
Dr. Fabre-Palaprat 



561 



39. Influenza at Berlin. 
Hufeland - 



By. Dr. 



564 



CONTENTS, 



303 



AMERICAN INTELLIGENCE. 



Page. 

Trial for Infanticide. By Dr. Tho- 
mas, M. D. of Westchester, 
Pennsylvania ' - 565 

New Remedy in Intermittent Fe- 
ver. By William A. Gillespie, 
M. D. .... 567 

Case of Oesophagitis. By John B. 
Zabriskie, M. D. - - ib. 

Case of Amnesia cured by Cup- 
ping. By J. B. Zabriskie, M. D. 568 

Tables exhibiting the number of 
White Persons in the United 
States, at every Age, deduced 
from the last Census. By J. 
Ingersoll Bowditch - - ib. 

A Case of Peritoneal Inflammation 
occupying the Left Horn of the 
Uterus, the Bladder, and a por- 
tion of the Rectum, in which Air 
was repeatedly expelled from 
the Urinary Bladder. By Charles 
Hale, M. D. - - - 570 



Page. 

Notice of a curious Case of Som- 
nambulism. By E. Bartlett, M. 
D. (Extracted from a letter to 
the editor.) - - - 571 

Case of Pityriasis Rubra cured by 
Chloride of Lime. By John B. 
Zabriskie, M. D. - - ib. 

Note from Dr. W. C. Wallace, of 
New York, relative to the Ante- 
rior Membrane of the Eyeballs 572 

Beaumont's Experiments on Di- 
gestion --.. ib, 

Bourgery's Treatise on the Minor 
Surgical Operations - - ib. 

Wood and Bache's Dispensatory 
of the United States - - ib. 

Tuson's Dissector's Guide - ib. 

Dartmouth College - - ib. 

Transylvania University - ib. 

Berkshire Medical Institution ib. 

Index - 573 

Advertisements - - 577 



ERRATA. 

Page 305, line 17 from bottom, for " left" read " right J 



dm? Journal ofMectt .somas. 
Feb*. im 




Gibson? case of Tumma" of Hie 3Tec7c 



ElUfrnvuLh,/ JZh-aijtvif fhui a '■■■■ H '"' - 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



Art. I. Case of Extirpation of a Tumour of the Neck, in which the 
Carotid Artery and Internal Jugular Vein were Tied — with Remarks. 
By William Gibson, M. D. Professor of Surgery in the Univer- 
sity of Pennsylvania. [With a plate.] 

George Washington Reynolds, seventeen years of age, 

came to Philadelphia from Delaware in November, 1832, and placed 
himself under care of Dr. Horner, on account of a tumour of the 
size and shape of a cocoa-nut, which occupied the whole of the left 
side of the neck. Dr. Horner referred him to me, and at the same 

I time requested the opinion of Dr. Physick on the case. The friends 
of the patient stated that the swelling had made its appearance five 
years before, that it arose without evident cause, and had gradually 
increased to its present magnitude. The boy now sought relief, on 
account of the difficulty of breathing and of deglutition he experi- 
enced, and which increased with the growth of the tumour. In other 
respects he felt no inconvenience from it; his complexion was florid 
and healthy, and his constitution apparently sound and vigorous. In 
consultation, it was determined that nothing less than extirpation 
would aftbrd a chance of recovery, and I was requested to undertake 
the operation. Previously, however, I thought it adviseable to reduce 
the patient by blood-letting, low diet, and other antiphlogistic means, 
both to diminish haemorrhage, and to guard against inflammation. 
Having fulfilled these indications, I commenced the operation, (No- 
vember 20th,) assisted by Drs. Horner and J. R. Barton, in the 
No. XXVI.— Feb. 1834. 27 



306 Gibson's Case of Extirpation of a Tumour of the Neck. 

theatre of the Alms-house Infirmary, in presence of several hundred 
students. The patient was placed, at full length, on a narrow table, 
his head inclined to the right side and supported by a pillow. An in- 
cision two inches long was made over the course of the carotid, low 
in the neck, and that vessel tied by a single ligature. Over the most 
prominent part of the tumour, commencing immediately under the 
angle of the lower jaw, and extending nearly seven inches, another 
incision was made through the integuments; continuing the line thus 
chalked out, layer after layer of condensed cellular membrane, of fas- 
ciae, and the fibres of the platysma myoides, were successively divid- 
ed, as well as those of the sterno-mastoideus, which last muscle was 
spread out by pressure of the tumour, and converted into a thin mus- 
cular expansion, intimately incorporated with the platysma, and ren- 
dering it difficult to distinguish one from the other. During this stage 
of the dissection the internal jugular vein was exposed, tied by two 
ligatures, and divided between them. The ends of the vein were then 
dissected from the surface of the tumour and turned to one side. In 
order to get round the tumour, and raise it from the cavity in which 
it was deeply imbedded, it became necessary to separate the integu- 
ments, fasciae, platysma, and other coverings. This proved very dif- 
ficult, and was not accomplished without great risk, owing to the dis- 
tribution of the par vagum and descendens noni nerves, both of which 
lay on the surface of the tumour, and were closely attached to it. I 
soon found it was impossible to get out the tumour, and at the same 
time preserve the descendens noni. I therefore cut it across. In- 
stantly a slight shudder passed over the patient's frame; but the ef- 
fect was momentary. I determined, however, not to divide the par 
vagum — dreading the result either immediately or remotely. I was 
obliged, therefore, to dissect along the edge of the nerve for five 
inches, and succeeded in detaching it from the tumour to which it 
had formed a very close adhesion. This was the most painful and dif- 
ficult part of the operation, and nothing but the uncommon compo- 
sure and fortitude of the boy, perhaps, enabled me to accomplish my 
purpose — for he remained during the whole operation motionless, and 
neither complained, sighed, nor groaned. The par vagum having 
been thus pushed aside and out of danger, I continued the dissection, 
taking up occasionally small vessels, sometimes separating with the 
handle of the knife the adhesions between the tumour and a firm 
fibrous sac, in which I now found it enclosed, at other times using 
the edge of the knife until I reached the base of the tumour, which 
was intimately connected with the pharynx and oesophagus, and to 
remove it from which required every possible precaution. In this, 



Gibson's Case of Extirpation of a Tumour of the Neck. 307 

also, 1 at last succeeded, though not without the division of four or 
five vessels, which at first shed blood freely, but were soon tied, or 
shrunk of their own accord. The action of the pharynx and oesopha- 
gus was distinctly seen, even at a distance, whenever the boy imitat- 
ed the action of swallowing, or took fluid by the mouth. The cavity 
left by the tumour was even larger than had been anticipated, owing 
to the influence of pressure upon all the surrounding parts. To guard, 
against return of haemorrhage, the patient was left on the table for 
twenty minutes, and the edges of the wound held together tempora- 
rily. No haemorrhage occurring, the wound was dressed regularly by 
adhesive straps, &c. and the patient put to bed. The operation lasted 
thirty-four minutes. 

The tumour having been cut open and examined in presence of the 
class, was found to consist of a medullary-like matter, of rather 
firmer texture, however, than that usually met with in fungus haema- 
todes. The idea was at once impressed upon my mind, and for the 
first time, that such indeed was the nature of the disease. The un- 
usually healthy appearance of the boy, and in particular his florid 
complexion, (circumstances so uncommon in fungus nematodes, 
which is almost invariably accompanied by a sallow, cadaverous coun- 
tenance,) had prevented any of us from entertaining suspicion of the 
kind. There was not, moreover, the elastic feel, and deceptive sen- 
sation of fluctuation, so characteristic of fungus haematodes. 

22c?. Slight cough and fever; tongue furred. 

23c?. Pulse and cough increased. Patient kept on barley water. 

Q4th. Slight uneasiness of chest; no increase of fever, and little 
thirst; tongue very red with white scurf. 

9.5th. Redness over whole abdomen, resembling erysipelas, but no 
pain; administer enema. 

26th. Redness of abdomen diminished after injection. 

9,7th. Redness gone; wound partially united, but suppurating 
abundantly. Barley water continued. 

28//i. No fever. Tongue nearly natural. 

9.9th. Wound closed, except where ligatures emerge. 

December 1st. Patient complains of being starved; barley water 
continued notwithstanding. 

8th. Diet increased to tea and bread, morning and evening. 

11th. Small ligature came away from corner of wound under ear. 

22c?. Ligatures pulled away from veins. 

97th. Ligature from carotid came away. 

January 3d — Wound entirely healed, and patient discharged, 
apparently in good health. 



308 Gibson's Case of Extirpation of a Tumour of the Neck. 

Some weeks afterwards the boy returned to town, with a tumour 
half the size of the original one, occupying the same situation. The 
cicatrix had ulcerated, and there was discharged from the opening a 
sanious ill-conditioned matter. Fungus, also, was presented at the 
opening, and seemed to extend within the interior of the swelling. 
The patient's countenance was pale and ghastly, his skin of a waxy- 
yellowish hue, and his body emaciated. I saw that nothing more 
could be attempted for his relief. It was evidently a case of fungus 
haematodes. He was advised to return home, and shortly afterwards 
died in a dreadful condition. 

Remarks. — There are two points connected with the operation just 
detailed, which give it an interest it might not in other respects, 
perhaps, be entitled to — the application of a ligature to the internal 
jugular vein, and the division of important nerves. It is an opinion 
generally received among surgeons, that large veins cannot be tied 
without great risk of inflammation of their internal surface speedily 
following, and proving fatal by extending to the heart. Such cer- 
tainly has been the result in numerous instances in European prac- 
tice, but it is equally certain that the occurrence in this country is 
extremely unusual, for out of a great many instances in which I my- 
self have tied varicose saphense veins, and have seen the operation 
performed by others, I have never met with a single case of injury, 
much less of death, from such a cause. The only instance, indeed, 
that has ever come to my knowledge of death from tying the saphena 
vein, occurred a few years ago in this city in the practice of a res- 
pectable surgeon. There were circumstances, moreover, connected 
with that case, which rendered it very doubtful whether the unfavour- 
able issue was owing to the operation, or to other causes. I think it 
very probable, therefore, that the constitutions of patients in this 
country, (owing to all classes of people being well fed and clothed, 
and little exposed to hardships,) are generally superior to those of 
Europeans, and as such more capable of resisting the operations of 
injury or disease. Whether this be true or not, however, it is cer- 
tain, judging from the details published by European writers, that 
the patients that have fallen a sacrifice to phlebitis, occasioned by the 
ligature of veins, have very generally been among the lowest classes, 
whose constitutions were of the worst kind, and whose operations 
were performed in the crowded hospitals of large and unwholesome 
towns. I do not wish to be understood, however, to say that there 
is no danger from including a large vein in a ligature. On the con- 
trary, I am well persuaded that there is always more or less risk, 
much greater risk, indeed, than would follow the tying of a large ar- 



Gibson's Case of Extirpation of a Tumour of the Neck. 309 

tery. I only mean to imply that there is less danger in tying a vein 
than is commonly imagined. Influenced by this opinion I ventured, 
in the case I have related above, to tie the internal jugular in two 
places. There are only a few examples on record, I believe, in 
which this vein has been tied, and most of them had a successful ter- 
mination. The operation was first performed, there is reason to be- 
lieve, by Dr. Simpson, of St. Andrews, in Scotland, eighty years ago, 
and the patient recovered without a bad symptom. Mr. Simmons, of 
Manchester, in England, also tied up the internal jugular, and with 
a similar result. Giraud has recorded a case in which a French sur- 
geon, at Toulouse, tied the trunks of the common carotid artery and 
internal jugular for a wound from a musket-ball. The patient had 
no unfavourable symptoms as far as the sixth day; but it is not stated 
whether the man recovered. In this country the internal jugular has 
been tied by Drs. Mott and Stevens, of New York, by the former 
in 1828, and by the latter in 1830. Both patients recovered. Some 
interesting remarks on the ligatures of veins, in which cases and ex- 
periments have been detailed, have been published by Trousseau, 
and may be found in the 14th vol. of the " Archives Generates de 
Medecine." The author is induced to conclude that there is less 
danger from tying a vein than is commonly imagined, and that the 
danger is often owing to prematurely pulling the ligatures away, and 
other mismanagement on the part of the surgeon. Fatal cases of 
wounds of the jugular veins have been reported, and the death of the 
patients attributed to the introduction of atmospheric air. 

The division of the descendens noni in the case of Reynolds pro- 
duced little or no inconvenience, it will be seen, to the patient — 
owing no doubt to this nerve being chiefly destined to supply the mus- 
cles of the neck, and holding no important connexion with the vital 
organs. The dissecting up the par vagum, by which it was more or 
less disturbed, probably gave rise to the erysipelatous inflammation 
of the abdomen — this nerve having an intimate relation to the sto- 
mach, intestines, &c. A division of it during the operation would 
probably have produced great disturbance in the animal economy, or 
have led, remotely, to the patient's death. The only further remark 
I deem it necessary to make in relation to this case is, that could I 
have known the tumour to have been of the nature of fungus nema- 
todes, I should certainly not have undertaken to remove it — upon the 
ground, that there is not a single well-attested case on record in 
which this inveterate malady has been successfully removed by extir- 
pation, and very few where the patient has recovered after amputa- 
tion. 

27* 



310 



Williams on the Viola Ovala. 



Art. II. On the Medical Uses of the Viola Ovata. By Stephen W. 
Williams, M. D. of Deerfield, Mass. 

r I0LJ1 0VJ1TJ1. Synonym. Viola primulifolia, Pursh. Rattle- 
snake violet. Specifcc Description. It is thus described by Nuttall. 

Leaves ovate, subcor- 
date, crenate, rather 
acute, often lacerately 
toothed at the base; 
equally and for the 
most part conspicuous- 
ly pubescent on either 
side, petiole marginat- 
ed; scape shorter than 
the leaves; segments of 
the calyx subciliate; pe- 
tals obovate, the two la- 
teral ones bearded. On 
dryland. Flowers bright 
blue; flowers in April 
and May. (North Ame- 
rican genera.) I have 
ventured to give it the 
English name of rattle- 
snake violet, from the 
fact that it is generally known here by the name of the rattlesnake 
plantain, from its efficacy in curing the bite of that reptile. 

Medical use. — The fact which I shall relate with regard to its effi- 
cacy in arresting the direful effects of the bite of the deadly rattle- 
snake may be implicitly relied on. Dr. Wells, when living, was 
considered one of the most eminent, judicious, and observing physi- 
cians which Massachusetts has ever claimed. His medical precepts 
and opinions are treasured up by many of his successors with religious 
veneration. 

Let it not be objected to the Viola ovata that we are not acquaint- 
ed with the active principle of the plant which thus rapidly arrests 
the progress of one of the most terrible accidents to which humanity 
is liable. The principal substance which can be extracted from it is 
mucilage, and this is best done by infusion in water. It yields a 
greater proportion of it than any of the violets, and nearly as much 
as the same quantity of slippery-elm, (Ulmus fulva;) hence it is much 
in use in dysentery, diarrhoea, strangury, and other affections of the 
urinary organs. Other medicinal qualities may reside in the plant, 




Williams on the Viola Ovata. 311 

but I have not discovered them. I cannot persuade myself that its 
specific qualities reside in the mucilage, for other substances yield 
mucilage in greater abundance, and are not considered alexipharmic. 
We ought always to be governed by facts rather than speculative opi- 
nions. Who can explain the reason why variola vaccina protects the 
system against the ravages of small-pox ? and yet who can doubt the 
fact? If we can establish the prophylactic qualities of the rattlesnake 
violet upon as firm grounds, or if we can be instrumental in saving 
the life of a fellow being labouring under the effects of the bite of this 
venomous reptile, our object will be accomplished. 

Many years ago rattlesnakes abounded in the vicinity of this place. 
Since the land is cleared they are rarely to be seen. Our old people 
were in the habit of using this violet for their bites. They generally 
know it by the name I have designated. The venerable Henry Wells, 
M. D. late of Montague, successfully employed it in these cases. To 
his statement respecting it I wish to draw the attention of physi- 
cians. He was called to a patient who was bitten by a rattlesnake, 
and who was labouring under all the symptoms of a diffusion of the 
venom. His body was enormously swoln, respiration laborious, and 
his skin livid. He immediately directed a strong infusion of the rat- 
tlesnake violet, and constantly bathed the wound and body with it. In 
a few hours the tumefaction subsided, the febrile symptoms abated, 
and the patient was considered nearly out of danger. He retired to 
rest, and gave directions with the nurse to give the violet tea often 
during the night. The patient continued so much better that the 
nurse became negligent, and omitted the directions, and fell asleep. 
From this suspension of the remedy the patient relapsed, the febrile 
symptoms returned, and the body was swoln like a puff-ball. The 
doctor was called, and again directed the remedy as before mention- 
ed: the symptoms yielded, and from a continuance of the remedy two 
or three days he completely recovered without the use of any other 
means. Dr. Wells related the above fact to my father, who was for- 
merly a physician in this town, and at the same time showed him the 
plant, which my father perfectly recollected when I collected it for 
preservation in my herbarium. 

My grandfather, Dr. Thomas Williams, formerly of this town, was 
in the constant habit of using a plant for the bite of the rattlesnake, 
which he called the rattlesnake plantain, and he was uniformly suc- 
cessful in the use of it. His practice as a physician and surgeon was 
very extensive. I have no doubt that it was the violet now under 
consideration. 
I have within a few days ceased visiting a little patient who says 



312 Williams on the Viola Ovata. 

that a short time before I was called to him he was bitten by a small 
green snake upon the top of his foot. Not long afterwards he was at* 
tacked with pain in his leg, attended with considerable swelling and 
high fever. I did not see him until he had been labouring under these 
symptoms some time. When I first saw him I did not apprehend 
that the fever, tumefaction, &c. proceeded from the bite of the snake, 
for I was not aware that its bite was venomous. I put him upon the 
antiphlogistic plan of treatment, and applied the vegeto-minerai 
water to the inflamed leg. The next day I visited him, and found 
his symptoms aggravated, and the swelling increasing. I threw aside 
the mineral water, and directed emollient fomentations with the rat- 
tlesnake violet, and a poultice made with bran stirred into the liquor 
of the infused leaves. The next morning I was highly pleased with 
the success of the applications. The tumefaction had subsided, and 
the fever abated. I left him under a confident expectation that he 
would soon recover. In the course of the afternoon, however, an offi- 
cious, intermeddling old woman sent word to the parents of the pa- 
tient that my applications were improper, and that nothing would 
cure him but a cold application of the leaves of houseleak, (Semper- 
vivum tectorum,) which was accordingly applied. The consequence 
was an universal chill, succeeded by delirium, and an intense burn- 
ing fever, from which he was not relieved under several days. He 
was immediately attacked with pain and inflammation in the groin 
of the other leg, attended with a good deal of swelling. I was imme- 
diately sent for, but could not go until the next morning. I directed 
the violet fomentations and poultices again. In about a fortnight sup- 
puration occurred, and I let out about half a gill of pus upon the tibia, 
about half way between the knee and instep. The other leg conti- 
nued swelled three or four weeks longer, when, by the continued ap- 
plication of the violet poultice, it subsided. 

I have since used the infusion of this violet, and a fomentation 
with the leaves of it in an obstinate case of chronic inflammation of 
the eyes, which had resisted the long-continued use of a great variety 
of remedies. The patient had used the slippery-elm and various other 
mucilaginous preparations with no success; in fact, with rather an ag- 
gravation of the complaint. Within a fortnight from the time she com- 
menced with the violet infusion no traces of inflammation about the 
eyes remained. So it appears it must be some other quality in the 
violet than its mucilaginous properties which must have effected the 
change. I am determined in future to use it extensively in the phleg- 
masise, both acute and chronic. 

Deerfield, Massachusetts, August 1st, 1833. 



Gerhard on the Cerebral Affections of Children. 313 

Art. III. Cerebral Affections of Children. By W. W. Gerhard, 
M. D. of Philadelphia. 

1 HIS essay upon the cerebral affections of children will be divided 
into two distinct parts; the first containing the cases I have collected 
during a year's observation at the Children's Hospital of Paris, and 
the second consisting in an analysis of my own observations, and of 
such others as are contained in special treatises, or in the collections 
of the journals. From these two sources I shall probably derive suffi- 
cient materials to elucidate many points relative to the pathology of 
these diseases, and after separating such facts as seem clearly esta- 
blished by rigorous evidence, I may facilitate inquiries of subsequent 
observers. The cerebral affections of children are too rare for col- 
lecting a large mass of personal observations in a year's study; but 
their number, although insufficient for the resolution of many im- 
portant questions is much larger than could have been met with in a 
long period of private practice, and will aid in the correct apprecia- 
tion of the facts related by observers. Little other value is attached 
to these cases than as specimens of disease, and as proofs that criti- 
cism is not extended to other writers without previous study of the 
natural phenomena at the bed-side and in the amphitheatre. This lit- 
tle personal experience will be perhaps partially compensated by the 
absence of all preconceived notions as to the nature, relative import- 
ance of symptoms or frequency of lesions in these cases; many of the 
observations are incomplete, none of them perfect, but they have all 
been collected without the desire of confirming any previous opinion, 
or of reaching other results than such as will be warranted by rigor- 
ous deductions. I have avoided examining the works upon these af- 
fections, and have even abstained from comparing my own observa- 
tions with each other, believing that during a series of observations I 
should pursue the safer course to avoid ail risk of forming a prema- 
ture opinion upon a subject still intricate and obscure. These pre- 
cautions may appear trivial, but such as are most familiar with the 
difficulties of observation will readily perceive the danger of theore- 
tical opinions, and understand the utility of extreme caution in avoid- 
ing all suggestions which might give a false colouring to a course of 
observations in actual progress; as soon as the series is complete, the 
examination of the facts related by others is both appropriate and ne- 
cessary. Such a method of study seems to me the only means of ar- 
riving at truths which subsequent experience will confirm, instead of 
the vague notions thrown out by one author and rejected by his sue- 



314 Gerhard on the Cerebral Affections of Children. 

cessor as false and untenable. The phenomena of disease are like the 
facts of the natural sciences subject to laws, pursue a regular march, 
and tend towards a natural termination by the recovery or death of 
the individual. The important difference, however, between medi- 
cine and the study of the ordinary phenomena of nature, is that we 
have an infinitely more complicated science, demanding a greater va- 
riety of knowledge, requiring the consideration of a multitude of ex- 
ternal agents which modify the usual phenomena, and from the na- 
ture of the object, a thinking active being, obliging us to confine our 
means of investigation to a narrow limit. These difficulties render 
rigorous observation more painful, but more necessary, and show the 
futility of theories and vague notions in a science which requires a 
more careful study of facts than any other: a chemist performs his ex- 
periments and then states his deductions, but physicians too often 
form their theory and afterwards search for facts to sustain it. In 
short, few questions can be resolved without a direct appeal to na- 
ture; and it is only from facts well established and carefully analyzed 
that uncontested truths can be deduced. I have thought it due to the 
reader to explain the methods of study pursued, and to state my firm 
conviction that no other means are capable of establishing what is po- 
sitive in medicine than the simple observation and comparison of facts. 
A large portion of the medical world is not yet convinced of the 
practicability of this sort of investigation, and some physicians affect 
to disdain these painful researches, and imagine that it is the part of 
an humble order of intellect to be confined to the naked facts instead 
of indulging in those vast combinations which indicate a superior 
mind. But as the object principally to be attained in every scientific 
research is the discovery of truth, and not the gratification of indivi- 
dual vanity, the means to be pursued in the investigation are such as 
lead most surely to this end, and the physician who has courage suf- 
ficient to devote himself first to the rigid proof of the existence of the 
phenomena, and who will afterwards investigate their relations and 
seek to interpret the facts, pursues a more logical and useful course 
than he who discovers, or imagines that he has discovered an isolated 
cause with which he seeks to establish the connexion of the numerous 
facts that he witnesses. Indeed, the numerical method of observation, 
or in other words, the careful examination of facts followed by their 
numerical comparison is now recognised by a large number of physi- 
cians as the nearest approach to the method of study employed in the 
other sciences, with this difference, that the phenomena which we in- 
vestigate are transitory and cannot be reproduced at pleasure as che- 
mical or physical experiments, the proof of which is always readily 



Gerhard on the Cerebral Affections of Children. 315 

confirmed without the necessity of cyphers, which are indispensable 
to establish the more or less constant succession of the variable phe- 
nomena of disease. The imperfection of the method is not contested, 
but it is evidently the least imperfect of all; more truth and less 
error will be published by the observers who reason directly from their 
facts than by those physicians who are less rigorous — who simply 
write from imperfect recollection, and who attempt to fill up all 
voids with the creations of their fancy. Thus observation is essen- 
tially progressive, each succeeding observer fixes his point of departure 
at the spot where his predecessor had terminated his researches, and 
necessarily advances a little in the knowledge of truth; the progress 
depends on the epoch, not on the observer. 

The cases of cerebral affections about to be related, comprise all those 
occurring in the boy's wards of the children's hospital at Paris, during 
eight months, from the first of August, 1832, to the 1st of April, 1833 % 
during the four months, from the 1st of April to the 1st of August, 
1833, all the cases admitted into the girl's wards will also be found in 
the collection, besides a few others that were collected before I had 
commenced a regular series of observations, or which I witnessed 
in divisions of the hospital in which I was not at the time habitually 
occupied. They were all mortal excepting two, which presented 
a totally different series of symptoms from those remarked in the 
other subjects. The classification is based upon the anatomical le- 
sions of the cerebral organs, and is merely made for the convenience 
of the reader; in a subsequent article it will be retained or modified 
in conformance with the results of analysis. The title cerebral affec- 
tion comprehends all the diseases in which the predominating symp- 
toms consisted in some modification of the cerebral or nervous func- 
tions, excluding of course the cases of simple somnolence, stupor or 
delirium, and not even admitting convulsions or other grave symp- 
toms which were merely the precursors of death, and not permanent 
or essential elements of the disease. Some examples of these cases 
will be given to establish the evident distinction between the two 
classes. Three divisions are for the present adopted; the 1st includes 
such subjects as presented some evident incontestable lesion of the 
brain or its membranes without the existence of well-characterized 
tuberculous or other accidental tissues; the 2d includes the cases in 
which these accidental structures coincided with the cerebral symp- 
toms, and the 3d the subjects offering doubtful or extremely slight 
anatomical traces of disease. To complete the series it will be neces- 
sary to enumerate such cases as presented a lesion of the brain with- 
out being preceded by marked symptoms during life. The anatomi- 



316 Gerhard on the Cerebral Affections of Children. 

cal classification is the most precise, and being based upon material 
facts, which are recognised without much difficulty, the transition is 
afterwards more easy to the cases which terminate happily. 

Observation I. — Rebours Alfred, six years of age, entered the 1st 
of February, 1833. Born at Paris. 

The following history I obtained from his mother, a woman of re- 
markable intelligence. He is the second child, was attacked with 
convulsions at the age of four months, immediately after a fall upon 
the floor, the convulsions returned frequently, especially during the 
period of dentition, which commenced at nine months and terminated 
at the age of three years: at this last epoch he was taken with croup, 
(diagnosis of the physician who attended him;) during the disease 
convulsions supervened, leeches were applied behind the ears, but 
the convulsions returned four times. From the age of three to four 
years he enjoyed perfect health; an eruption of scarlatina then appear- 
ed preceded by convulsions, which ceased as soon as the eruption be- 
came general. At five years he had measles, with return of convul- 
sions before the eruption. Since that time he has had no convulsions, 
his health good, excepting a fever in August last accompanied with 
diarrhoea. He was vaccinated five times without success; has had an 
eruption of varicella, but neither small-pox nor hooping-cough. The 
child is very intelligent, lively, and impetuous; learns readily; was 
fat and strong until August last, since that time he has become thin- 
ner, but has not coughed. Eight weeks before his entrance an erup- 
tive disease of the scalp appeared, which no longer existed notwith- 
standing the application of irritants to keep up the secretion at the 
end of four weeks. 

On the 2d or 3d of January he fell in going to school, striking the 
back part of the head; sinco- that time he complains of head-ache, but 
did not cease going to school until the 16th, when, after some days 
of increased cephalalgia, especially when near the stove, he returned 
home, complaining of severe pain in the head, and immediately vo- 
mited a greenish liquid. He was put to bed, and eight leeches were 
applied behind the ears; their application threw him into a violent fit 
of anger, accompanied with a convulsion characterized by the move- 
ments of the eyes and strong contractions of the limbs. From that 
time he was confined to his bed, the vomiting returning on several 
successive days. Since the month of August he has had a diarrhoea 
of five or six discharges daily, which ceased, and was replaced by 
obstinate constipation eight days before the symptoms. He has had 
fever; the convulsions have returned very frequently up to his en- 
trance, especially after a second application of leeches to the tem- 



Gerhard on the Cerebral Affections of Children. 317 

pies three or four days previously, which was again followed by vio- 
lent anger. Delirium within two or three days only. 

Present condition, February 2d. — Hair and complexion fair; rather 
thin; skeleton well formed; decubitus dorsal; face pale; features not 
much distorted, but risus sardonicus when spoken to, and frequent 
grimaces, extending to all the muscles of the face, with slight spas- 
modic movements of the jaw and lips — the corner of the mouth a lit- 
tle drawn towards the right side. Eyes not injected, slight strabis- 
mus of the right, pupils neither dilated nor contracted, natural; 
stupor constant, but easily dissipated on speaking to him; answers 
are sometimes correct, at others incoherent; delirium and cries during 
the night; movement and sensibility natural, without rigidity; he asks 
for food more frequently than drink; tongue trembling, moist, whitish 
and villous at the centre, reddish at the edges, not evidently deviat- 
ed; deglutition easy; abdomen retracted, appears tender to pressure; 
no dejections; heat pungent and dry; pulse 80, small and feeble, but 
regular; respiration 26, irregular, a little elevated without dilatation 
of the nostrils, pure. Milk; hot pediluvia with ashes, (twice;) potion of 
Chaussier. 

Sd, 9 Ji. M. Delirium during the night, commencing at 8 o'clock 
last evening; since daylight he is calm; same decubitus; profound 
coma; eyes hollow; pupils dilated, contracting a little in a bright 
light, without a marked difference in size, regular, slight strabismus 
of the right eye; sensibility of the skin generally much increased, the 
slightest touch interrupting the coma and producing complaints; he 
complains of pains in the forehead, but says he has none elsewhere. 
Movements of the limbs natural, without the least rigidity; mouth 
slightly drawn to the right side, frequent movements of the lips; an- 
swers generally correct; voice natural; deglutition easy; heat dry, 
but not acrid; breath fetid; cough rare; pulse 80, regular; respiration 
20, irregular, unequal; percussion of the chest sonorous, respiration 
vesicular without rhonchus; occasional complaints of pain in the ab- 
domen. Potion of boric acid repeated; calomel, gr. iss. ; 5 enema; 
diet. 

5 P. M. No subsultus observed; heat increased; pulse 120, quick 
and regular; respiration 30, high, irregular; same stupor, but some- 
times he asks for drink. 

4th. Coma alternating with delirium; convulsive movements of the 
limbs at noon; the other cerebral functions carefully examined offer- 
ed no change since the 3d, still constipated; abdomen retracted, the 
same complaints on pressure as on the rest of the surface; no plain- 
tive cries, or cough or dejection; urine twice or three times in the 

No. XXVI.— Feb. 1834. 28 



318 Gerhard on the Cerebral Affections of Children. 

day, as previously voluntary; pulse at 5 o'clock 136, small, quick, and 
regular; respiration 20, irregular and high. Same potion of 3j- boric 
acid to gv. of vehicle; 2 pediluvia with mustard; milk. 

5th, 8 A. M. Agitation and delirium during the night; same de- 
cubitus, knees more elevated; face paler; eyes more hollow; mouth a 
little opened, not evidently distorted; eyes closed habitually, same 
state of pupils; ill humour if touched; no rigidity of the muscles; sen- 
sibility of the skin generally augmented; the purple spots noticed at 
his entrance have now nearly disappeared; answers rather more dis- 
tinct; cephalalgia; no subsultus; abdomen retracted— he complains 
when pressure is made upon it; thirst; deglutition easy; he never asks 
for food; constipation; skin hot; pulse 104, quick, small, regular. 
R. Calomel, gr. v. in three doses at two hours interval; enema with 
^ss. of castor oil; sinapism to feet, twice; potion with boric acid. 

6th. Delirium during the night; same decubitus; mouth at 
present slightly deviated towards the left side; face pale; lips 
red, not swollen; eyelids adhering from the dried secretions; pu- 
pils dilated; strabismus doubtful; sensibility diminished, movement 
as before; no subsultus; coma more profound; answers extremely 
rare; skin hot; pulse 119, trembling, feeble, irregular; respiration 
irregular, high, stertorous, 20 per minute; abdomen retracted, indo- 
lent; no dejections. A drop of croton oil; blisters to the legs. De- 
glutition easy; the croton oil was followed by a copious evacuation 
half an hour afterwards; but the same coma which existed since 7 
o'clock in the morning continued; no convulsions nor cries. 

7th, 8 A. M. The same symptom continued during the evening of 
yesterday; some involuntary movements of the arms were observed; 
mouth closed, both commissures depressed, the left more than the 
right; pupils equal, less dilated, perfectly insensible to a strong light; 
insensibility complete without rigidity of the right limbs, the left are 
less insensible, not rigid; some vague motions of the arm occasional- 
ly; no subsultus; no replies; deglutition still possible; skin cool; pulse 
feeble, trembling, but regular, 180; respiration stertorous, 43; abdo- 
men very retracted, indolent; another copious dejection during the 
night. An hour later the pulse was insensible. 

Death at 3 P. M. 

Autopsy the 9th, forty -two hours after death. — Exterior. Slight 
rachetic deformity of the knees and feet; rigidity of all the limbs, es- 
pecially the inferior; slight lividity of the thighs and posterior parts 
of the body, which is pale in general; slight emaciation. 

Head. A little blood flows from the exterior of the dura mater: 
longitudinal sinus empty; arachnoid very dry on the convex surface 



Gerhard on the Cerebral Affections of Children. 319 

of the brain, no serosity beneath it; convolutions of the brain flat- 
tened; pia mater injected, especially posteriorly in the large veins, it 
may be detached without tearing the cortical substance. The arach- 
noid upon the convexity is neither transparent, nor granulated. Base, 
presents a general yellow or straw colour in its middle portion, in- 
cluding the pons varolii, medulla oblongata, a part of the anterior and 
middle lobes of the cerebrum, the polygon behind the optic nerves, 
and nearly the whole of the inferior face of the cerebellum. The 
arachnoid in the yellowish portions has lost its ordinary polish on its 
free surface, and presents beneath it, (that is, in the pia mater,) a 
yellowish concrete, firm matter, similar to concrete pus, and not 
very friable. The thickness of this substance or false membrane is 
very variable — near the commissure of the optic nerves it is about a 
line, diminishing towards the anterior and lateral parts of the cere- 
brum. The anterior lobes of the cerebrum adhere together by a nu- 
merous net-work of vessels; they cannot be separated without tearing 
the cerebral substance. Between the crura of the cerebrum, and be- 
neath the yellowish substance described, we found an ecchymosis of 
blood which penetrated into the substance of the crura along their 
internal face to the thickness of one to two lines; the same infiltra- 
tion of blood into the cerebral substance extends continuously into 
the two fossa of Sylvius to a greater degree and for a more con- 
siderable distance in the right than the left. The sides of the fossae 
adhere by abundant filaments formed apparently by vessels and 
the yellowish concrete substance. The optic nerves adhere strongly 
to the brain. Arachnoid in general may be detached without injuring 
the cortical substance. Lateral ventricles contain about three ounces 
of limpid serosity in the two cavities. Consistence of the cerebrum 
normal, cortical substance moderately coloured; the medullary a lit- 
tle dotted with blood — the part of the crura nearest the ecchymosis 
is a little yellowish but firm. Cerebellum pale, firm; arachnoid rather 
more adherent than on the cerebrum. Pons varolii and medulla ob- 
longata firm, pale. Foramen of Munro dilated, fornix and septum 
lucidum as well as the three commissures retain their usual aspect. 
Spinal marrow firm, white. 

t&bdomen. Stomach containing a dark-coloured mucous liquid; mu- 
cous membrane grayish, neither mamillated nor injected; consistence 
normal; strips three to five lines in great tuberosity, six to eight on the 
faces, one to two inches on the small curvature. Duodenum yellowish, 
containing very few crypts. — Small intestine. Upper half coloured 
yellow by the contents; the valvulse a little greenish; no redness ex- 
cepting at the lower part of the ileum, which offers some arboriza- 



320 Gerhard on the Cerebral Affections of Children. 

tions; consistence every where good; glands ofPeyer little promi- 
nent, of the same colour as the adjoining membrane; isolated follicles 
not noted; mesenteric glands firm, not tuberculous, of the usual 
size. — Large intestine. Contents not noted; coecum .and ascending 
colon offer numerous arborizations which cease in the transverse co- 
lon, the membrane afterwards is pale; consistence every where good; 
strips more than an inch in length. — Liver of middle size, of good con- 
sistence, not fatty; gall-bladder contained a dark bile. — Spleen three 
inches in length, containing a small tubercle. — Kidneys firm, livid. — 
Bladded contracted. 

Thorax. Lungs a little engorged with blood, especially on the left, 
but crepitant and permeable, not hepatized nor tuberculous; some 
bronchial glands of different size are tuberculous, yellow, and friable. 
Heart presented nothing remarkable-— details not noted. 

The previous history in this case is more perfect than can be ob- 
tained from many children at the Enfans Malades; the child was born 
of parents subject to convulsions, the same disposition seems to have 
been transmitted to their children. The subject of this observation 
was intelligent, lively, but irritable and delicate, subject to cerebral 
symptoms when other diseases existed, each application of leeches 
augmented instead of diminishing the convulsions. An accidental fall 
upon the head seems to have been the exciting cause of the symptoms 
which preceded death. These followed an ordinary course — vomit- 
ing, constipation, somnolence, delirium, coma, with convulsions. 
The anatomical lesions of the arachnoid were very marked, but the 
brain presented a lesion of its substance, consisting in a yellowish 
colour of the crura without softening, and an ecchymosis of consider- 
able extent. Some tubercles existed in the bronchial glands, but not 
elsewhere. The intestinal canal offered nothing remarkable, notwith- 
standing the habitual diarrhoea.* 

* The following" details were learned as to the health of the relatives of the 
child. His mother is now 28 years of age, well formed, but pale. She men- 
struated at 15 years, was married at 18, is subject to convulsions from infancy, 
which increased in frequency from the age of 9 to 15 years, since then they have 
been less frequent, but not influenced by pregnancy; within the last three or four 
months she has had no attacks. She has had four children, the subject of the ob- 
servation is the second; two others died of convulsions, at the ages of fourteen 
days, and eleven months: the youngest, a little girl six months old, is still living; 
she had a number of convulsive fits during the first six weeks after birth, she 
was then vaccinated, and has had none since. The father was also subject to 
attacks of epilepsy in childhood, but not since the age of 15 years. Neither the 
paternal nor maternal grandparents were known to have had convulsions. 



Gerhard on the Cerebral Affections of Children. 321 

Observation II*. — (Service of M. Jadelot.) Deucar Theodore, 
eleven years old, born at Marseilles. Spare habit, eyes and hair dark 
colour, habitual health good excepting some scrofulous abscesses on 
the limbs, the cicatrices of which are visible, one or two still present 
fistulous openings; lives in a damp porter's lodge with his parents, 
and within the last three months has been frequently obliged to sit 
up at night with his sick mother. 

July 8th, 1832. — He was perfectly well, had not been up during 
the preceding night, went to bed in the evening, slept well until 5 
o'clock in the morning, when he awoke with a sensation of dizziness, 
every thing seemed to turn around him, at the same time he was 
taken with nausea, and vomited a quantity of green bitter matter, 
followed abundant perspiration without previous chill. The vomiting 
was repeated ten or twelve times during the day. At 7 A. M. fron- 
tal cephalalgia, very intense, persisting during the whole day, with 
dizziness, anorexia, great thirst, a little colic, but no evacuations, 
urine abundant. During the night of the 8th and 9th he was awakened 
once or twice by the violence of the head-ache. 

9th. Increase of the cephalalgia and vertigo, vomiting but only in 
the morning, eyes painful in a bright light. At 9 o'clock severe 
pains in the abdomen, and followed by one evacuation. At 11 chill 
with vomiting, afterwards fever and sweating which lasted almost 
all day. At 1 P. M. he is brought to the hospital. From that moment 
the dizziness ceased, but the cephalalgia was still very intense, thirst 
greater, urine abundant, perspiration copious during the whole night. 

Jlctual state, July 11th, morning. — Coloration of the face and body 
generally natural; intelligence. (Preceding details furnished by him- 
self.) Answers prompt, distinct; frontal cephalalgia moderate; he 
has never felt formication or drowsiness; pupils contractile, light 
easily tolerated; thirst intense; appetite doubtful; neither nausea nor 
colics; abdomen well formed; tongue rose at the edges, villous 
and pale at the centre, moderately moist; no cough; respiration pure; 
pulse 72, developed, regular; skin hot and moist, appearance of good 
health, but sensation of feebleness; thinks he could not walk. Vene- 
section, §viij.; ^ enema with gtt. iv. laudanum of Sydenham; poultice 
to abdomen; infusion of mallows; milk. No change during the day 
except profuse perspiration in the afternoon, in the evening vomited 
several times after taking some broth; sleep very sound. On the 
morning of the 12th cephalalgia rather more severe, no dizziness, 

* Read by M. Mannoir to the Societe Medicale d'Observation, the 27th Oc- 
tober, 1832. 

28* 



322 Gerhard on the Cerebral Affections of Children. 

thirst moderate, appetite good, abdomen yielding, not tender; tongue 
not so white, skin moist; pulse 80, less developed than yesterday. 
The blood drawn from the arm presents a thick, firm, black coagulum, 
not buffed, serum moderately abundant. Tisane of liquorice and 
nitre; common enema; cataplasm to the abdomen, with %i. laudanum 
of Rousseau; broth. 

From the ISth to the 17th the state of the patient improved daily, 
after a warm bath on the 13th the cephalalgia disappeared, the appe- 
tite was good, thirst natural, dejections natural, no chills or per- 
spiration or pain in any part of the body; pulse counted in the morn- 
ing was always between 70 and 80, regular; one vomiting the 16th 
after taking some soup which he disliked; he asked permission to 
leave his bed. 

On the evening of the 17th no change having occurred during the 
day, the patient is suddenly affected with severe frontal cephalalgia 
without previous chill, the pain was most severe on the left side; the 
eyes became painful on exposure to the light; night agitated. 

18th, at 9 A. M. Pain in the head continues, the patient is deject- 
ed, face rather pale than red, eyes half-closed, painful when exposed 
to the light, pupils contractile, equal, sight natural, slight somnolence; 
intelligence perfect, anorexia, no thirst; abdomen yielding, not tender; 
skin hot and dry; pulse 68, full, regular; during several of the pre- 
ceding evenings it was a little more frequent, with increase of the 
heat of the surface. Eighteen leeches to abdomen, emollient poultice 
afterwards, fomentations of mustard to legs; tisane of liquorice; tar- 
taric lemonade. 

On the 19th the same cerebral symptoms continued, especially the 
head-ache which was constantly more severe on the right than the 
left temple; somnolence great, the patient attributes it to the bright 
daylight; answers obtained with difficulty; expression of pain, nausea, 
and two liquid stools this morning without colic; during the night 
cough and frequent sneezing; the respiration is pure but feeble; he 
complains of pain in the throat in swallowing; pharynx natural; 
pulse 60. Six leeches behind the left ear, ten behind the right; cold 
compresses to the head; sinapisms to legs; tisane. 

%0lh. Pain in the head persisted after the application of the leeches, 
but diminished during the night; eyes constantly closed; answers 
slow, reluctant, but perfectly correct; cough and pain in the throat 
diminished; sinapisms to eyes; emollient cataplasm to abdomen; vine- 
gar poultices to the ankles. 

2,1st. Without pain when at rest, but as soon as he is touched or 
moved, he cries and complains of suffering pain. Right eye painful, 



Gerhard on the Cerebral Affections of Children. 323 

he resists strongly any effort to open it; left eye not painful, opened 
voluntarily; pupils natural, contractile; head inclined towards the 
right side; both arms equally sensible to the touch, muscles contract 
with equal force. Friction to the chest, with tinct. camphorae, et 
vini cinchonse, aa. 3iv. ; ether acet. ^j.; infusion tiglise; vinegar 
poultices to feet; warm bath; musk, gr. iij. in six pills. 

22d. Less cephalalgia; motion still very painful; somnolence; the 
child neither speaks nor moves during the whole day; says he is 
thirsty, and desires food; abundant perspiration yesterday, especially 
in the evening; night tranquil. Same prescription. 

23d. Amelioration continues; pain in the head moderate, confined 
to the right temple; motion more easy; decubitus indifferent, variable; 
less drowsy, but answers still unwillingly; perspiration again profuse 
last evening; appetite and thirst great; tongue rosy at the edges, yel- 
lowish and villous at the centre, moderately moist; lips encrusted 
for some days past; breath fetid since his admission into the hospital. 
During the last five days the pulse was between 60 and 70, full, and 
regular; slightly irregular on the morning of the 23d; respiration na- 
tural; skin always hot and dry, excepting during the sweat just men- 
tioned; heat increased in the evening; no vomiting; a little nausea 
the 20th; tongue rosy, pale, villous and moist. Every day from two 
to five liquid dejections without colic; thirst generally moderate; 
urine abundant; abdomen yielding, not tympanitic nor tender; face 
emaciated, not highly coloured; expression sad, indifferent; eyes al- 
most constantly closed. 

On the morning of the 24th he said he was much better, and felt 
no pain. Sleep natural; somnolence much diminished; answers not 
so slow; skin warm and moist; pulse 64. At 2 P. M. his parents 
visited him, and found him with his eyes opened, perfectly awake, 
but notwithstanding the most pressing entreaties they could not ob- 
tain from him a single word of reply. No delirium during the 
night. 

25th, at^Jl. M. Decubitus on the left side; the left cheek repos- 
ing on the palm of the hand; inferior extremities semiflexed; attitude 
perfectly natural; air of complete indifference, and half stupor; not 
the least answer; he seems not to perceive that questions are asked; 
face slightly coloured, especially at the cheeks; no distortion; eyes 
half open, move naturally in their orbits; the right pupil more than 
two lines in diameter, even when exposed to a bright light is slightly 
irregular, and nearly insensible; the left is smaller, contractile, re- 
gular; expression of pain, and frowning when his head is touched; 
much more resistance in extending the left than the right arm; 



324 Gerhard on the Cerebral Affections of Children. 

movement however still voluntary, for the patient replaces the left 
hand on his head immediately after its release; sensibility pre- 
served in both superior extremities, but somewhat obtuse in the 
lower; respiration 30, regular, a little elevated; pulse 62, regular, 
rather full; temperature of the face and arms natural, that of the 
body and lower extremities a little elevated; skin dry; abdomen 
hot, tympanitic; upon pressing it the muscles contract without caus- 
ing grimaces; one rose, lenticular spot and two or three particles on 
the abdomen. Blister to the back of the neck; fomentations of mustard 
to the legs; musk, gr. iij. in six pills; frictions with acetic ether. 
Same state during the day and night; no delirium; stools and urine 
involuntary. 

26th. Decubitus dorsal; sensibility of upper extremities equally 
obtuse, the right is in a state of nearly complete resolution, and falls 
heavily when raised up, but still capable of some slight voluntary 
movements; the left sensible to pain, and contractility natural, but a 
few moments after the examination it offered a marked contraction, 
the wrist and forearm in semiflexion, impossible to extend, when the 
effort is made the marks become tense and resist most strongly; sen- 
sibility not very obtuse in the lower extremities; motion voluntary; 
skin hot; pulse 80, rather full; respiration SO, high, regular, noisy 
at times; slight cough; brownish froth on the lips; breath very fetid; 
abdomen flattened, resisting. Calomel twelve grains in three doses; 
eight leeches to the right temple. Same state; but respiration more 
stertorous. Death at 9 P. M. 

Jiutopsy the %8th, thirty-eight hours after death. — Tempera- 
ture rather cool; lividity of the whole posterior part of the trunk; 
abdomen greenish. 

Head. Blood rather abundant at the exterior of the dura mater; 
a long semitransparent fibrinous coagulum in the longitudinal sinus; 
some very slight adhesions between the cerebral arachnoid and that 
of the dura mater; general aspect of the convolutions flattened, 
and rather moist; the large cerebral veins of both hemispheres, but 
especially the left, are engorged with blood, between them are a mul- 
titude of fine arborizations giving to the external surface of the brain 
a general red colour; around the large veins mentioned, but not in 
the intermediate space, the arachnoid is of a light straw colour, semi- 
opaque, as if a very small quantity of pus had been deposited around 
these vessels; this appearance is irregularly distributed on the two 
hemispheres, more marked on the lateral and middle part of the 
right hemisphere, where upon cutting through the arachnoid little 
masses of that substance of the appearance and consistence of buffy 



Gerhard on the Cerebral Affections of Children. 325 

coat of blood can be detected from the surface of the brain; no infil- 
tration beneath the arachnoid; pia mater detached with difficulty, 
tearing a little the cerebral substance, especially on the right side; 
the cortical portion is of a violet tint, evidently a deeper colour than 
in the natural state, but of good consistence, except in the right tem- 
poral region a little above and anterior to the ear, where it seems 
a little softened; below this point it has a slightly yellowish tinge, 
and forms a little mass, of the size of a large bean, rather hard, tra- 
versed by a large number of voluminous vessels, whose orifices are 
open, and contain blood and not pus; the same aspect is presented 
in the fossa of Sylvius, into which this yellowish hard substance is 
introduced, it is a line and a half thick, and traversed by open ves- 
sels, strongly adherent to the two lobes forming the fossa, and sur- 
rounded by a thin layer of softened cortical substance. 

At the base of the brain the yellow semi-opaque matter existed 
around the vessels which enter the two fossae of Sylvius, but to a 
much less degree on the left than the right side; the same appearance 
was found around the veins of that portion of the superior face of the 
cerebellum, without softening of the subjacent cineritious substance. 
The medullary substance of the brain is moderately dotted with 
blood, of a light violet tint; each lateral ventricle contains two or 
three tea-spoonfuls of limpid serosity; the central portion, especially the 
posterior pillars of the fornix and the septum lucidum, are very easily 
torn, a touch reduces them into little filaments floating in the serosity 
of the ventricles, their whiteness is perfectly preserved; plexus cho- 
roides pale; corpora striata, optic thalami, annular protuberance and 
cerebellum offer no lesions; the sinuses of the base of the brain are 
filled with black blood half liquid, half coagulated. 

Thorax. Pericardium contains half an ounce of transparent sero- 
sity; heart, size of the fist of the subject; right cavities containing 
much coagulated blood, and a little fibrine; the left very little blood; 
parietes of the left ventricle from four to five lines in thickness, those 
of the right two; left pleura contains an ounce of reddish serosity; 
left lung without adhesions, retains its form after removing it from 
the chest, of a general pale violet colour; several groups of blood- 
vessels are remarkably developed beneath the pleura at the lower 
part of the upper lobe; the pulmonary tissue in the upper lobe is 
reddish-brown, very crepitant, spongy, containing little blood; the 
lower lobe offers the same aspect in the greater part of its extent, 
in some points only are nuclei of a pale colour, the section is granu- 
lated, contains no air, and is very friable; bronchi pale, containing 
some puriform mucus; a bronchial gland on the outer side of one of 



326 Gerhard on the Cerebral Affections of Children. 

the largest, is converted into yellowish and blackish cretaceous mat- 
ter; right pleura contains no serosity; the upper half of the right lung 
presents some cellular adhesions easily broken; the surface is of the 
same colour as the left, and presents some bands of interlobular em- 
pyreuma; pulmonary tissue fawn colour, containing little blood in 
the upper lobe, but more in the lower, though without traces of em- 
pyreuma. Larynx pale, perfectly healthy, containing a little puru- 
lent mucus; same contents in the pharynx. 

Abdomen. No serosity in the peritoneum; stomach of middle size, 
contains three or four ounces of black liquid, mixed with little black- 
ish flocculi; mucous membrane presents a marbled-rose-colour with 
some large arborizations, and a little dotted redness along the small 
curvature; the membrane yields even in the large tuberosity strips of 
two to four lines, more than an inch in the small curvature, and five 
or six lines every where else; slight mammillation near the pylorus; 
small intestine brownish externally, containing a little dark yellow 
mucus; invagination two or three inches in length in the mid- 
dle of the intestine; a little brownish matter, and one lumbricus 
in the last half of the intestine; a few isolated crypts are visi- 
ble at the commencement of the jejunum, but none near the end of 
the ileum, in which are eight or ten agglomerated glands, irregular, 
little prominent, of the same colour as the intestine, dotted with black 
points; general colour of the mucous membrane like that of the con- 
tents; thickness natural; consistence good; strips three or four lines 
in length in the jejunum, six to eight in the ileum, the last half of 
which presents some delicate arborizations; mesenteric glands small, 
grayish-rose colour, firm; large intestine contracted, containing some 
soft fecal matter; mucous membrane pale, slightly rose coloured, 
with some scattered arborizations; follicles with black central points 
visible beneath the membrane; thickness and consistence normal, 
strips eight to twelve lines. Liver extrude a little beyond the ribs, 
brownish-slate colour, firm, containing little blood. Spleen three 
inches long, pale claret tinge, good consistence. Kidneys firm, 
livid red, containing much blood. Bladder contains half a glass of 
urine with an abundant flocculent sediment; internal membrane finely 
injected, firm, not thickened. 

I am indebted for this observation to my friend Mr. Mannoir, of 
Geneva, who collected it during the period we were both engaged in 
observing at the children's hospital. It is relative to a scrofulous 
child who had not perfectly recovered his health, and besides the un- 
favourable circumstances of a damp, gloomy lodge, and the nearly ab- 
solute privation of exercise to which a large number of the children 



Gerhard on the Cerebral Affections of Children. 327 

of porter's are condemned at Paris, he was obliged to undergo 
unusual fatigue in nursing his mother. The affection offered three 
distinct periods, the first characterized by vomiting which lasted two 
days, dizziness, somnolency, sensibility of the eyes, frontal cepha- 
lalgia, these symptoms diminished perhaps partly from the effects of 
the depletion. The second period, we remark return, and augmen- 
tation of the cephalalgia, especially on the right side; the cerebral 
functions are not more affected than in the first period, there is 
neither delirium nor alteration of the sensibility or motility; the third 
period was announced by the loss of consciousness, and the paralysis 
of sensibility of the upper extremities, with contraction of the left 
side, and complete relaxation of the right. The whole duration of 
the disease was eighteen days, the complications were slight and 
confined to a little diarrhoea. The anatomical lesions consisted in 
the infiltration of purulent matter at the base of the brain, but not 
considerable effusion into the ventricles; the cerebral substance was 
softened in a limited extent near the surface, and also the central 
part of the brain, but the nature of the latter lesion is not yet satis- 
factorily known, and certainly in the present case, in which the 
autopsy was made a considerable time after death, might have existed 
independently of any cerebral affection. The thorax presented no- 
thing but some cretaceous matter in one of the bronchial glands, a 
fact insignificant in itself, but highly interesting when viewed in con- 
nexion with the scrofula with which the patient had been affected, 
The bronchial glands in children frequently present the tuberculous 
degeneration without traces of it elsewhere, a circumstance not ob- 
served in adults; attention should be turned towards these glands at 
all the periods of life, as the history of their lesions may aid in clear- 
ing the important question of the cure of tubercles. The abdominal 
viscera offered nothing remarkable. The treatment was equally un- 
successful in this case as in those which follow. 

Observation III.* — A boy, fifteen years of age, entered the Salle 
St. Jean, the 6th of August, 1832. (Service of M. Jadelot.) His 
father communicated the following details. He left the Hospital of 
La Pitie six weeks before his entrance; he had there been treated 
during a fortnight for cholera, which still was epidemic at Paris. He 
has never perfectly recovered his strength, although he returned to 
his work, (cabinet-maker,) but was unable to perform as much la- 
bour as usual. He complained of frequent pains in the head and ab- 
domen. 

• Read to the Societe Medicale d'Observation, September, 1832. 



328 Gerhard on the Cerebral Affections of Children. 

Four days before his admission he was taken with nausea and vo- 
miting, twice repeated, of green bitter matter, at the same time he 
had diarrhoea during two days, frontal cephalalgia, and insomnia, 
with slight cough. At his entrance he complained of cephalalgia, in- 
telligence dull, answers extremely vague; chest sounds well on per- 
cussion; respiration pure; abdomen yielding, well formed, but pain- 
ful, especially on pressure. During several days regular notes were 
not taken. The patient constantly complained of pain in the abdo- 
men without either diarrhcea or tympanitis. M. Jadelot directed the 
day after his admission twenty -five leeches to be applied to the abdo- 
men, and cold water to the head. The 9th he was bled; delirium 
came on the following night; agitation great before the venesection. 

12th. Persistence of delirium. Eighteen leeches behind the ears, 
and ice to the head. 

13th. Delirium augmented; constipation persists since his entrance. 
Venesection, gviij.; sinapisms to legs; ice to the head. After this 
date the observation was collected regularly. 

Present state, July 14th.— Skeleton well formed; moderate embon- 
point; complexion sallow; decubitus variable; vague unmeaning 
movements of the arms; stupor, accompanied with agitation, and 
frequently delirium characterized by unmeaning cries and words; 
insomnia nearly complete; frequent sighing and cries, but not appa- 
rently indicative of pain. He understands questions in a loud tone, 
and answers correctly, but the delirium is only momentarily inter- 
rupted; frontal cephalalgia; sight troubled; eyes dull, half-closed, but 
pupils contractile, not dilated, of natural appearance; no strabismus; 
hearing imperfect, with tinnitus aurium; sensibility and movement of 
all the limbs natural; face not distorted; heat moderate but dry; 
neither sudamina nor typhoid spots on the skin; tongue brown- 
ish, a little dry; teeth fuliginous, mouth remains half opened: 
abdomen retracted, presenting nothing on the exterior but the leech 
bites, some of which are in suppuration; pulse 80, a little irregular; 
respiration very irregular, alternately very frequent or slow; percus- 
sion of the chest sonorous anteriorly; respiration pure. Infusion of 
marsh mallow with syrup of ether; common enema; cataplasm to ab- 
domen; diet; with grs. v. calomel in the evening. 

15th. Delirium and insomnia during the night; this morning at times 
gay and laughing, at others sighs and plaintive cries; constipation 
persists; urine involuntary; pupils contractile, the left although ex- 
posed to a more direct light more dilated than the right; subsultus 
tendinum very frequent at the wrist; pulse 84. Warm bath; cold 
water to be applied to the head, and cataplasm to the abdomen; com- 



Gerhard on the Cerebral Affections of Children, 329 

mon enema; sinapisms to legs. The pulse was at 92 in the evening; 
respiration 28; tranquil in the bath, but subsultus tendinum rather 
increased; no amelioration followed it. 

16th. Slept a little; delirium continues with the same characters; 
some floccilation, and efforts to detach his linen by pulling it forci- 
bly; no sighing, but delirium less easily interrupted; answers less 
connected; pupils much dilated, especially the left, without strabis- 
mus; he moves his right arm much more than the left — both are gene- 
rally semiflexed, resisting an effort to extend them; rigidity most con- 
siderable in the left arm, where it was doubtful on the 15th, but he flexes 
both hands at will, the left less strongly than the right; the same 
slight rigidity exists in the lower extremities, especially the left; hic- 
cough at intervals; abdomen tympanitic, a little tender on pressure; 
pulse 96, regular, quick, moderately developed; tongue dry, brown 
at centre, red at the edges; teeth as before. Blister to back of neck; 
stimulating frictions to chest and arms; emollient cataplasm to the 
abdomen; cold water to the head; tisane with nitre. 

Evening. Tremor extending to nearly all the muscles of the body; 
pulse 96; no other change. 

17th. Night agitated; delirium has now changed in character, less 
noisy, but more difficult to suspend, marked by muttering rather than 
cries; tremor of face and limbs continues; subsultus frequent; rigidity 
of the muscles of the face, head, and neck; muscles of the jaw resist 
strongly any effort to depress it, but afterwards he opens the mouth 
voluntarily; sensibility always nearly natural; pupils directed up- 
wards, irregularly dilated, but equal; pulse 92, a little irregular, but 
quick and resisting; tongue less dry; skin hot and dry; abdomen tym- 
panitic. Tisane of liquorice and nitre; inf. tiglise; enema of starch 
with gtt. v. laudanum; milk diluted. 

Evening. Coma more intense; rarely complains, and then feebly, 
and half articulately of pain in the head; countenance entirely chang- 
ed; sensibility a little diminished on the left side. 

l&th. Tremor constant and general, causing a general appearance 
very like that of a person shivering after a cold bath; subsultus fre- 
quent; jaws firmly closed, very rarely opened; floccilation; no an- 
swers; rigidity marked in both arms and in the left leg; sensibility 
diminished in the limbs that are rigid; pulse 120, difficult to examine 
on account of the frequent subsultus; tympanitis extreme; grimaces 
when the belly is touched. Syrup of ether; stimulating frictions; inf. 
tigliae. Pulse 144 in the evening; no cries; tremor persists. Same 
state in other respects. 

Death on the 19th at 5 A. M. 

No. XXVI.— Feb. 1834. 29 



330 Gerhard on the Cerebral Affections of Children. 

Autopsy the 20th, twenty-nine hours after death. — Exterior. Ema- 
ciation slight. Abdomen greenish, meteorized, two or three ulcera- 
tions corresponding to leech bites exist at the epigastrium. No oedema. 
Rigidity of the limbs moderate; some violet strips at the posterior 
part of the trunk and limbs; muscles firm, red. Placing the sub- 
ject on the belly, an abundant greenish yellow liquid flowed from the 
nose and mouth. 

Head. A little blood on the exterior of the dura mater; longitu- 
dinal sinus entirely empty; no effusion into the great cavity of the 
arachnoid nor beneath the membrane at the convex surface of the 
brain; pia mater can be easily detached from the brain, its vessels 
are moderately distended with blood. — Base. The arachnoid covering 
the commissure of the optic nerves is yellowish, opaque, and presents 
a thickness of three-quarteisof a line, caused by the effusion beneath 
it of a pale yellow matter resembling concrete pus and very adherent. 
The arachnoid covering the anterior part of the annular protuberance 
presents the same semi-opaque aspect, but with less thickness. The 
part of the membrane upon the superior face of the cerebellum is also 
of the appearance just described, but only in the sort of crescent 
formed by that organ near the tubercular quadrigemina, that is the 
most anterior part of it. From this sort of crescent the yellow sub- 
stance extends upon the cerebellum to the breadth of three or four 
lines, until the arachnoid gradually resumes its transparency. The 
membrane is thickened but not yellow in the fossa behind the crura 
of the cerebellum, in the rest of its extent it retains its ordinary as- 
pect, except on the lateral part of the right hemisphere where it is 
a little rosy, apparently from ecchymosis. The large vessel con- 
tained within the fossa of Sylvius of the right side, is filled with a 
black and firm coagulum, and surrounded with a dense whitish mat- 
ter, grating beneath scalpel, and except in colour resembling the 
yellow substance described: it forms a sort of sheath around the ves- 
sels, and agglutinates the parietes of the scissure. A similar lesion 
but to a less degree exists on the left side. The convolutions on 
the summit of the brain are a little flattened, the cortical substance 
pale, and the medullary very little injected. Brain throughout firm, 
and of its normal appearance. About two ounces of serosity contain- 
ed in the two ventricles flowed from an incision into the right. Cere- 
bellum and annular protuberance of normal firmness, very little in- 
jected. The arachnoid covering the first inch of the medulla oblon- 
gata is a little opaque, hard and thickened. Spinal marrow firm, 
white without appreciable lesion. Very little serosity at the base of 
the brain, or in the spinal cavity. 



Gerhard on the Cerebral Affections of Children. 331 

Neck. Larynx grayish, not ulcerated. — Pharynx pale, not ulce- 
rated. 

Thorax. Pericardium contains about an ounce of reddish serosity. — 
Heart flaccid, containing a fibrinous coagulum infiltrated with serosity 
in the right cavities, a little fluid blood in the left. The whole internal 
coat of the heart and great vessels is of a livid-rose colour.— Pleurae, 
each contains a little reddish serosity, some slight cellular adhesions 
on the left side. — Left lung crepitant, distended with air, greenish 
in some points; tissue in both lobes bright red, light, and contains a 
certain number of gray semitransparent granulations a little tinged in 
green, and separated by healthy tissue; no tubercles nor hepatizations. 
Right lung presents the same aspect, and similar granulations scatter- 
ed throughout its upper and lower lobes, the middle contains one or 
two tubercles of the size of peas, not softened. At the bifurcation 
of the bronchia there is a ganglion of the size of a small walnut, com- 
pletely transformed into yellow tuberculous matter, marked with 
dark bands and not softened; a few tubercles are scattered beneath 
the costal pleurae. 

Abdomen. Three or four ounces of reddish serosity in the perito- 
neum. — Stomach of moderate size, contains some black liquid; mu- 
cous membrane much wrinkled, of a grayish tint, with a few scatter- 
ed arborizations, not mammillated, but containing within its thick- 
ness in the two inches nearest the pylorus an abundance of little 
white points of the size of pin's heads, scarcely projecting above the 
level of the membrane; thickness normal, strips from three to five 
lines in the great cul-de-sac, seven to eight great curvature, and 
more than an inch in the small; (a long rusty pin is in the midst of 
the contents.)— Duodenum tinged by the bile, containing a multitude 
of muciparous crypts. — Small intestine contains some gas, greenish 
externally, containing in its whole length a moderate quantity of mu- 
cous matter, greenish superiorly, but afterwards darker, and nearly 
black towards the end; the mucous membrane is alternately pale, 
and dark green in the points where the liquid existed; but in the 
last half where the blackish matter was found, it is nearly every 
where pale; thickness natural; consistence natural in the first half, 
strips of eight to ten lines even in the part where the green colour is 
most intense; in the second half the membrane is very thin, and 
yields strips only from three to five lines, the cellular tissue is em- 
physematous beneath it; (perhaps the partial softening is cadaveric;) 
agglomerated glands of Peyer scattered, but not abundantly in the 
last half of the intestine, they are slightly reticular, a little elevated; 
a few near the valve dotted with black points; a very few isolated 



332 Gerhard on the Cerebral Affections of Children. 

crypts of Brunner near the middle of the intestine, where there are 
some arborizations of small extent. — Large intestine distended with 
gas, containing an abundant black pultaceous matter; mucous mem- 
brane of a light greenish-brown in the coecum, where the strips are 
eight to twelve lines long; in the ascending colon it is pale, thin, and 
yields strips of nearly two inches long; in the transverse colon it is 
brownish, and offers some isolated follicles with central points, giving 
long and thin strips; in the rectum equally firm, but pale, and a little 
thicker.— Mesenteric ganglia small, pale, firm, not tuberculous. — 
Liver of the usual volume and consistence; tissue pale and containing 
very little blood; gall-bladder small, containing a little yellowish 
bile. — Spleen nearly four inches long, flaccid, brownish externally, 
livid internally. — Kidneys of the usual size, pale, the two sub- 
stances very distinct. — Bladder distended with urine; some large 
ecchymoses at the great fundus, and some fine arborizations in the 
rest of its extent; greenish in points, with an odour of putrefaction; 
mucous membrane yields strips eight or ten lines long, even in the 
reddest portions; the ecchymosis is common to the mucous and cellu- 
lar tissue. 

This case is defective as to the previous history of the patient, and a 
detailed examination was only made during the four last days of his 
life. The subject of this case was the oldest observed, the meningitis 
began in an enfeebled subject who was still suffering from the sequelae 
of cholera, and as the autopsy proved, he was tuberculous; it began 
by vomiting, slight diarrhoea succeeded by constipation, cephalalgia 
and insomnia. Delirium supervened on the eighth day, augmenting 
constantly until it was succeeded by profound coma previously to 
his death, which took place on the 18th. The other cerebral symp- 
toms were rigidity of the limbs, especially of the left side, beginning 
on the 14th day; floccilation, dilatation of the pupils, subsultus ten- 
dinum, and shivering of the whole body; no convulsions occurred 
during the hours I passed in the ward, (four or five daily.) Deglutition 
not noted; abdomen tympanitic, apparently sensible; constipation; 
slight cough; but pure respiration during the whole course of the dis- 
ease, which pursued a regular march, the symptoms gradually in- 
creasing in intensity until his death. The treatment which was not 
deficient in vigour at the beginning produced no sensible effect. The 
anatomical lesions of the brain consisted in an opacity of the arach- 
noid at the centre of the base, and in the fossa of Sylvius, espe- 
cially on the right side; but the cerebral substance was every where 
perfectly firm, and without the least appreciable lesion; the ventri- 
cles containing a moderate quantity of serosity. On the convex sur- 



Gerhard on the Cerebral Affections of Children. 333 

face the arachnoid was remarkably dry, and adhered closely to the 
convolutions which were evidently more flattened than usual. The 
other viscera offered nothing remarkable, excepting the existence of 
tubercles in the lungs and bronchial glands. The commencement 
was similar to that of the last case, but here there was a constant but 
gradual augmentation of the symptoms, delirium supervened on the 
eighth day; in other respects the analogy is very close, both in the 
symptoms and anatomical lesions. But I shall not extend the remarks 
on each case, as the general summary will necessarily contain the 
most condensed and important statement of the results obtained by 
the comparison of the individual observations. 

Observation IV. (Female ward; service of M. Jadelot.) — Erlemont 
Stephanie, five years and a half of age, entered the 18th of June, 
1833. Born in French Flanders, but now living in the Rue St. 
Jacques. Before her arrival at Paris in September last, she had en- 
joyed perfect health, excepting an intermittent fever which lasted 
during several months last autumn, (common in her province.) She 
has been vaccinated, has not had measles, or any eruptive disease 
of the scalp, has never had convulsions nor worms, does not cough 
habitually, and is not subject to diarrhoea; appetite and digestion 
good; her health and embonpoint were not impaired at her arrival at 
Paris, notwithstanding the indifferent food to which the distress of 
her parents had confined her for some months. Since her residence 
in the capital, food abundant; intelligence developed; some lympha- 
tic glands of the neck a little augmented in size within three months. 

In the month of February her parents observed that she limped; a 
tumour formed on the instep of the left foot, which suppurated in the 
month of March, and has constantly discharged a purulent matter 
since that time. She was confined to the house on account of the af- 
fection of her foot, but was perfectly gay and playful; appetite and 
digestion excellent. 

The 15th she was perfectly well; ate as usual at four o'clock; slept 
well until four o'clock in the morning, when her parents were awak- 
ened by the same plaintive cries she has so frequently uttered since; 
they then perceived that the left arm and leg were agitated by con- 
vulsive movements, but the members of the right side were stiff and 
motionless. Replies slow, reluctant, confined to yes and no; cries 
frequent, especially when agitated by the movements of the left side; 
mouth drawn to the left side during the convulsions, and permanent- 
ly distorted on the 17th — left eye opened in the attacks; strabismus 
not perceived; vomiting only on coming to the hospital in the car- 
riage; constipation since the beginning; she has eaten nothing but a 

29* 



334 Gerhard on the Cerebral Affections of Children. 

little soup with repugnance,* no thirst; she drinks sometimes when a 
cup is put to her lips, but often refuses; heat of skin great on the left 
side of the body, not on the right; sleep troubled. 

On the 19th of June she was not examined in consequence of her 
being placed by a mistake in a ward not appropriated to acute affec- 
tions. The symptoms as far as noted did not differ from those ob- 
served the 20th when I examined the patient. 

Present condition, June 20th, at 2 P. M. — Hair chesnut-coloured; 
embonpoint moderate; decubitus dorsal; head inclined to the right 
side; eyelids equally separated, leaving an interval of a line between 
the upper and lower; nostrils equally dilated, not in motion; lips vio- 
let but pale, and rather thick; the two commissures of the mouth de- 
pressed, mouth drawn a little towards the right side; sleep heavy, al- 
most stupor; face pale: in awakening she opens her eyes and looks 
around her, the face becomes more coloured; pupils equal, regular, 
contractile, without strabismus, look fixed; hearing evidently pre- 
served, but she seems not to understand the questions; humour tran- 
quil; she moves her left arm and hand, frequently closes her fingers 
upon the hand; movements of the left leg equally free; sensibility on 
that side natural, neither apparently increased nor diminished; right 
arm motionless, falling when raised up, but always in the direction 
of the flexor muscles; rigidity and semiflexion of the elbow and wrist, 
but not of the fingers; sensibility very feeble, on pinching the skin 
smartly she withdraws the arm but very little; right leg slightly flexed, 
lying on its external face, rigid, and very little sensible on pinching 
the skin; jaws closed, rigid, sometimes movement of the lower as if 
triturating food; head slightly inclined backwards; no replies nor ar- 
ticulate sounds, but sometimes vague, low cries; deglutition nearly 
natural, slow; no dejection since her admission. (Abdomen not noted.) 
During the examination her father came to visit her, she recognised 
him without speaking; ate some strawberries; demanding more by ges- 
tures of the left hand. Sinapisms to legs; blister to the back of the 
neck; infusion of mallows. Yesterday eight leeches were applied be- 
hind the ears, another similar application had been made to the tem- 
ples before her entrance. 

%lst, at 9 Jl. M. Pulse varying in frequency from 64 to 72, a lit- 
tle irregular; heat very moderate. 

3 P. M. Decubitus dorsal, abandoned; face pale; lips livid, pale, 
thick; eyes opened at times; pupils contractile, equal, of natural size; 
a slight change of position renders the face injected; nostrils open, 
not in motion; head inclined backwards; same state of the right arm 
and leg as yesterday, but the rigidity is now extended to the fingers, 



Gerhard on the Cerebral affections of Children. 335 

which are strongly flexed; left arm and leg still sensible; agitated 
frequently by movements, which seem voluntary; no subsultus; sight 
preserved, the eyes follow the movements of the hand or other objects 
held before them; no replies, cries not heard, but sighs very frequent; 
deglutition easy; no dejections. (Urine not noted.) Abdomen yield- 
ing, insensible to pressure; percussion of the chest sonorous; respira- 
tion pure and expansive. Prescription of the morning. Bladder of ice 
water to the head; six grains of calomel in three doses; cataplasms 
with vinegar to the feet; purgative enema; tisane of liquorice and 
nitre. 

22c?. Two doses of the calomel were taken last evening, and fol- 
lowed by a large evacuation in the night, (involuntary;) no convul- 
sions. 

9a «#• M. Face generally injected, but not of a livid-red colour- 
swollen since yesterday; lips same aspect; mouth not deviated; she 
opens her eyes, seems to see, but no longer follows with the eyes the 
movements of objects before them; pupils not contractile, equal, re- 
gular, a little dilated; same decubitus; right arm strongly contracted 
in all its articulations; the contractions of the muscles in most posi- 
tions resisting the action of gravity; contraction instantly returning 
after forcible extension; sensibility increased, she withdraws the arm 
a little when pinched; the left arm is now rigid, perhaps more than 
the right; the elbow, wrist, and fingers strongly flexed, sensibility 
seems less than on the right side; rigidity of the inferior extremities 
slight, but sensibility very feeble; deglutition slow and difficult; no 
replies, no convulsions, but as previously frequent increase of the stiff- 
ness of the limbs with slight spasmodic movements; slight voluntary 
movements now occur from time to time in the right arm; no subsul- 
tus nor strabismus; cough loose, rare; skin hot; partial perspiration 
of the face; pulse 140, regular, very feeble; respiration high, regular, 
36; chest sounds well on percussion, anteriorly and posteriorly; mu- 
cous rhonchus sometimes heard in the inspirations; palpitations of the 
heart accompanied with the bellows sound, (bruit de soufflet;) abdomen 
tympanitic, but insensible. Bath with cold affusions on the head; 
sinapisms to the legs; potion with ether; purgative injections. The 
bath produced no evident effect. 

23(Z, 8 A. M. Same decubitus; face pale; eyes open, the left more 
than the right, covered with mucus, but not injected, pupils contrac- 
tile, natural; nostrils dilate occasionally; mouth slightly open, a little 
drawn towards the left side; lips livid, pale; insensibility increased; 
rigidity persists on both sides, but now greater on the right than the 
left; deglutition impossible; respiration high, stertorous; no evacua- 



336 Gerhard o?i the Cerebral Affections of Children. 

tions; pulsations of the heart very feeble; chest sonorous anteriorly; 
mucous rhonchus very abundant on both sides; heat rather elevated; 
abdomen retracted, indolent. Tisane; cataplasms to feet. 

4 P. M. Pulse irregular, trembling, 96; respiration stertorous, 
high, 48; face more injected than in the morning, sensibility dimi- 
nished. 

Death at midnight. 

Autopsy the 24th, twelve hours after death. — Head. No blood on 
the exterior of the dura mater; a little serous blood without coagula 
in the longitudinal sinus. Arachnoid humid, but offering no serosity 
in its great cavity. Pia mater easily detached from the convolu- 
tions without destroying them; not at all injected; very little serum 
in some of the large veins only; arachnoid not thickened or granu- 
lated. — Base of the brain. The arachnoid around the commissure of 
the optic nerves, and in the space of rather more than half an inch 
posteriorly, was thickened, opaque, milky, but not offering a pseudo- 
membranous concretion. The left fossa of Sylvius presented a 
small number of hard, whitish granulations around the vessels, but 
neither false membranes nor injection. The right fossa presented 
a much larger number of granulations, forming clusters around the 
vessels; no false membranes; a little more injection than on the left 
side, but not to a considerable degree; very little serosity at the base. 
Cortical substance every where of a rosy tint, and very firm. Medul- 
lary moderately injected, firm. The lateral ventricles contained 
about three drachms of limpid serosity; the septum lucidum and for- 
nix very soft but not diffluent; more easily torn than in the majority 
of subjects examined even at the expiration of a longer interval after 
death. Cerebellum quite as firm as the brain, not much injected. 
Annular protuberance and medulla oblongata firm and white. The 
whole cerebral mass carefully examined, contained no tubercles. 

Spinal marrow. Vertebrae cautiously opened with the double saw 
of M. Charriere; after the section had been completed the spinal mar- 
row was seized at the base of the brain, and drawn a little towards 
the occipital foramen, after a very moderate traction it broke at the 
base of the cervical vertebras. In incising the dura mater, which was 
covered with some coagula of blood, the softening was found to exist 
in the extent of two to three inches in the part corresponding to the 
inferior cervical and superior dorsal vertebrae. The medulla retained 
its usual whiteness; the cortical and medullary portions distinct, but 
rather less so than usual; no vascular injection. In tearing the me- 
dulla by either of its extremities into ribbons, (which in the ordinary 
state can be done throughout the whole length,) they broke at the 



Gerhard on the Cerebral Affections of Children. 337 

softened part. Little serosity beneath the arachnoid, which was 
every where rather more closely adherent than usual. Larynx and 
trachea rose-coloured, not ulcerated. 

Thorax. — Left lung slightly adherent; at the upper and posterior 
part of the lower lobe it is crepitant; the upper lobe of a rose-fawn 
colour, and the posterior two-thirds of the lower of a dark red; at 
the part of this lobe a little cluster of opaque tubercles of the size of 
small peas surrounded by a hardened impermeable tissue not granu- 
lated; the rest of the lobe is merely engorged with blood. Right lung 
contains some blood in its posterior part, but offers neither dilatation 
of the vesicles, hepatization, nor gray granulation. Bronchi rose-co- 
loured, not dilated, containing a little mucus. Bronchial glands in 
part converted into tuberculous matter. 

Abdomen. Stomach of middle size, containing a little mucus. Mu- 
cous membrane offers a general rose tint without marked injection; 
aspect polished, not mammillated; neither increase nor diminution of 
its thickness; consistence perfect; strips two inches in the small cur- 
vature, six to eight lines in the great, four or five in the great tube- 
rosity. Small intestine of ordinary size, containing a yellowish liquid 
matter but no lumbrici. Mucous membrane throughout pale; consist- 
ence every where natural. Agglomerated follicles pale, little elevat- 
ed, of the usual reticular appearance: a few isolated follicles towards 
the end of the intestine. Mesenteric glands small, firm, not tubercu- 
lous. Large intestine contains a quantity of pultaceous fecal matter; 
follicles very little developed; mucous membrane throughout pale, of 
natural aspect and consistence, yielding very long strips. Liver firm, 
containing little blood, not fatty. Other viscera present nothing re- 
markable. 

The disease began suddenly without the usual precursory symp- 
toms, but as in the preceding cases, it occurred in a tuberculous sub- 
ject, who was also affected with scrofulous disease of the foot. The 
rigidity of the right arm was one of the first symptoms noticed, and 
at the very commencement was sufficiently marked to attract the at- 
tention of the parents of the child; it continued without intermission 
until death, which occurred much earlier than in the other subjects, 
at the end of the eighth day. The left side of the body was frequent- 
ly the seat of strong convulsive movements, and in the last two days 
offered a degree of rigidity as great as the right side. No delirium 
was noticed; the intellectual faculties were very obtuse, but still re- 
tained on the fifth when she evidently recognised her father. Vomit- 
ing occurred on the third day after the appearance of the other symp- 
toms; the constipation persisted during the whole affection. Passing 



338 Gerhard on the Cerebral Affections of Children. 

to the anatomical lesions we find very few traces of an affection of 
the cerebral mass; the granulations in the fossa of Sylvius, (more 
abundant on the right side,) were anormal, but whether they are to 
be regarded as the product of the acute affection, or as gray tubercu- 
lous granulations, is not perfectly certain. The softening of the spi- 
nal marrow was very remarkable; no doubt could be entertained as 
to its existence, for the autopsy was made before the body was per- 
fectly cold, and the spinal column was opened in such a way as to 
preclude the possibility of mechanical injury of the spinal marrow. 
The septum lucidum and fornix were also evidently softened, but the 
quantity of serum in the ventricles was inconsiderable. The treat- 
ment was entirely without effect; indeed, at the admission of the pa- 
tient it was evident that the termination would be fatal. 

Observation V. — Jeannette, 3et. 2, entered the 9th of June, 1833. 
(St. Catharine, female ward; service of M. Jadelot.) — The child was 
left at the hospital by her mother; she stated to the sister of the ward 
that the child had been sick five days, was constipated, but had not 
vomited. 

Present state, June 9th, at 3% o'clock, P. M. — Hair blond; com- 
plexion clear; face slightly rosy, but not red; lips rosy, of middle 
size; nostrils open, not in motion; eyelids equally opened; mouth 
nearly closed, not deviated; eyes gray, pupils insensible, contracted, 
equal; she does not open the eyes herself, the portion of cornea in 
contact with the air is covered with a film; the eyes are fixed, a little 
but doubtful strabismus; stupor profound; she neither sees nor hears; 
expression vacant; decubitus dorsal, abandoned; head inclined back- 
wards; muscles of the neck a little rigid; upper and lower extremities 
generally lying motionless, and falling nearly if not quite indepen- 
dently of the muscles when raised up; slight rigidity of the elbows, 
but doubtful; sensibility of the surface diminished, smart pinching of 
the skin is necessary to make her withdraw her arms or legs; at times 
she raises her hands in the air, moving the fingers as if in search of 
objects, at others she joins them at the top of her head; feeble, plain- 
tive cries when her head is moved, not uttered at other times; sub- 
sultus tendinum not remarked, nor convulsions; deglutition possible; 
pulse 7Q, feeble, irregular, both in the force and order of the pulsa- 
tions; respiration 28, elevated, expiration heard at a distance; skin 
rather below than above the natural temperature; percussion sonorous 
in the anterior part of the chest, which could not be examined minute- 
ly; abdomen yielding, insensible. Prescription, eight leeches behind 
the ears; sinapisms to the legs; six grains of calomel in two doses. 

10th, 9 J2* M. Face generally pale; decubitus dorsal; head in- 



Gerhard on the Cerebral Affections of Children. 339 

dined to the right side, abandoned; nostrils not dilated; features not 
distorted; mouth closed; lips livid; eyelids separated to the distance 
of two lines, leaving exposed a part of the cornea which is covered with 
a film of mucus; pupils directed upwards, not visible; coma profound; 
neither replies nor other evidence that she neither hears or sees; in- 
sensibility almost absolute; the limbs paralyzed, falling immediately if 
without support; countenance entirely altered, characteristic of cerebral 
disease; when much disturbed she moves her hands a little without di- 
recting them to any object; face and chest cool; hands hot; respira- 
tion high, 26; pulse 132, regular, and sufficiently developed; abdo- 
men yielding, insensible; no dejections. Ten leeches to the head, four 
of them behind the ears, the others to the temples; blisters to the 
occiput; frictions with ether to the limbs; common tisane. 

A.\ P. M. The heart had augmented; she moves her arms, and 
resists a little to the efforts to extend them, but without rigidity; eyes 
fixed, turned upwards; pulse 112, feeble and irregular. Death during 
the night. 

Jiutopsy the 12th, thirty hours after death. — Exterior. Embonpoint 
considerable; livid spots on the internal parts of the inferior extre- 
mities; no rigidity. 

Head. Almost no blood flows from the exterior of the dura mater; 
small fibrinous coagulum in the longitudinal sinus; convolutions 
flattened; anfractuosities nearly effaced; arachnoid dry, adhering 
closely to the surface of the convolutions; pia mater on the convex 
surface moderately injected in the larger vessels, and offering some 
patches of bright redness, on each side of the fissure between the he- 
mispheres, and extending along the greater part of its length, the 
arachnoid contains rounded whitish bodies of the size of a mustard 
seed to that of a grain of millet, much less friable than tubercles; 
these granulations are not to be confounded with the glands of 
Pacchioni, which are much smaller, of a pearly-whiteness, and most 
visible at the posterior part of the fissure where the granulations are 
very rare. The vessels on the convex surface of the brain, are ac- 
companied by little clusters of the same kind of granulations, but 
not sufficiently numerous to surround them; the arachnoid near them 
is opaque, but without increase of the general vascular injection. 
The hemisphere adhere at the bottom of the fissure by numerous cel- 
lular connexions easily broken by a little effort. Pia mater in gene- 
ral detached with difficulty, but the surface of the brain rarely torn 
on raising the membrane with ease. Base of the brain offers an ounce 
to an ounce and a half of limpid serosity. In both fossa of Syl- 
vius around the large vessels, 1 found a pseudo-membranous yellow- 



340 Gerhard on the Cerebral Affections of Children. 

ish-white concretion, not extending beyond the fossa, and half a 
line to a line in thickness; some little rounded bodies can just be dis- 
tinguished in the midst of this membrane, and from colour and con- 
sistence seem to be only another form of the same matter. The arach- 
noid covering the commissure of the optic nerves, and the polygon 
immediately posterior to them, is whitish, increased in thickness to a 
third of an inch by the concrete whitish substance effused beneath it, 
but can be detached more readily from the cerebral substance than 
this membrane on the summit of the brain. The opacity of the arach- 
noid extends to the adjoining parts of the base, and even to the su- 
perior and inferior surfaces of the cerebellum, disappearing by insen- 
sible gradations. The annular protuberance and medulla oblongata 
present the same aspect of the arachnoid, which is a little opaque to 
the termination of the superior third of the spinal marrow. Lateral 
ventricles contain an ounce and a half to two ounces of troubled 
milky serosity, but without injection or alteration of these parietes. 
Foramen of Monro rather larger than usual. Cortical substance of 
the cerebrum every where of a grayish-pink, the medullary portion 
less injected than usual. Corpora striata and optic thalami present 
a pink hue, a little different from that of the convolutions. The 
whole cerebral mass is of a perfect consistence. Septum lucidum 
and fornix white and firm; cerebellum not injected, a little less co- 
loured, and not quite so firm as the cerebrum, (normal state;) medulla 
oblongata and annular protuberance very white and firm. Spinal 
marrow. — Arachnoid transparent in the inferior two-thirds, containing 
about an ounce and a half of limpid serosity; substance white and 
firm. 

Abdomen. Stomach distended with mucosity; the great tuberosity 
is torn in separating it from the spleen; in this part of the organ all 
the tissues are grayish, softened, of a jelly-like aspect, and thickened; 
the same colour extends to all of them, but in a much greater degree 
to the mucous than the other coats. Anterior face irregularly shaded 
with livid, red spots, (of imbibition,) in other places it is yellowish or 
pale; its thickness is every where augmented, it yields no strips on 
traction, and is every where opaque; posterior face of a milky, dull- 
white colour, intersper